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The Millwood Partnership NHS GP Surgery in Bradwell

Request an appointment with a nurse or healthcare assistant

Request an appointment with a Nurse or Healthcare Assistant (COVID-19)

Required fields are labelled

COVID-19 Screening

Do you have either:

a high temperature – This means you feel hot to touch on your chest or back (you do not need to measure your temperature) Required

Yes

No

a new, continuous cough – This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual) Required

Yes

No

loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal Required

Yes

No

Have you been told by 111 to contact the practice? Required

Yes

No

Do you live with someone who has had a high temperature or a new, continuous cough? If their symptoms started more than 14 days ago, click No. Required

Yes

No

Please continue to fill out this form

Your symptoms suggest you might have Coronavirus (COVID-19). You should use the 111 online coronavirus service to find out what to do.

Who are you completing this form for? Required

For example, on behalf of a child or dependent

Yourself

Someone else

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

Are you happy for us to make sure this number is updated in your medical record?

Yes

No

Have you, or the person you are requesting for, been advised to shield yourself because of your health? Required

Yes

No

Have you, or the person you are requesting for, left your house since the end of March or since received advice to shield?

Yes

No

Please tell us what kind of trips you have made when you have left the house, for example medical appointments, shopping, etc.

Have you or the person you are requesting for, had anybody visit you in your home?

Yes

No

Please tell us who has visited you, for example a family member or carer:

Are other members of your household socially distancing from you?

Yes

No

The practice can send a text message to your phone with your appointment time. Required

I agree to the practice sending me text messages including appointment times

I do not agree to the practice sending me a text message with my appointment time

Appointment required (tick all that apply):

Blood test

Blood pressure check

ECG

Contraception (first appointment)

Contraception check

Vaccination

Wound management/dressing

Cervical screening

Baby immunisation

B12 injection

Hormone injection

Other

Blood tests information

Blood tests must be taken before 4.00pm.

You can also book blood tests directly using the NHS App or SystmOnline.

Tests must be requested by a clinician or as regular monitoring agreed for your medication. Please state who has arranged this or what medication you are having monitored: Required

Cervical screening:

I know that cervical screening is due now.

I am not sure when cervical screening is due. Please check records.

If you would like to request an appointment with a Nurse Practitioner, please complete the Get help for any health problem form instead.

If you require a health review, please do not request it using this form, please visit our Health Review and Assessment Clinic instead.

Please specify what other appointment:

Have you been told when to have the appointment, for example, “in the next two weeks” or “in one month’s time”? Required

Yes

No

When does the appointment need to be?

Tell us when you are available to have an appointment:

Tell us when you are available to have an appointment in the next three weeks:

Confirmation Required

I understand that the practice may need to send me a secure online message about my appointment. I will check my emails.

If you are human, leave this field blank.

The practice is currently closed

The practice is currently closed and this form is not available outside normal surgery hours. If you need medical assistance that will not wait when the practice is closed, please speak to a pharmacy or call NHS 111. You can also visit our treatment room for self -help for self help information on physical health or our Wellbeing Centre for information about mental health, sexual health, weight management and other lifestyle requests.

Millwood Surgery
Mill Lane
Bradwell
Norfolk
NR31 8HS

Get directions

01493 444484

Falkland Surgery
Falkland Way
Bradwell
Great Yarmouth
NR31 8RW

Get directions

01493 442233