Request an appointment with a Nurse or Healthcare Assistant

The COVID-19 vaccination is not yet available for any patients. We are unable to tell you when the vaccination will be available. Please see our COVID-19 Vaccinations page for more information.

Tell us when you want your appointment and we will reply to you with a time. Once we receive this form we will process it within 4 working hours.

If you require a health review, please visit our Health Review and Assessment Clinic.

If you require travel vaccinations, please first complete our Travel Risk Assessment.

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

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) *
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) *
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 *
Have you been told by 111 to contact the practice? *
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. *
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.

Section

Are you happy for us to make sure this number is updated in your medical record?
Have you, or the person you are requesting for, been advised to shield yourself because of your health? *
Have you, or the person you are requesting for, left your house since the end of March or since received advice to shield?
Have you or the person you are requesting for, had anybody visit you in your home?
Are other members of your household socially distancing from you?
The practice can send a text message to your phone with your appointment time. *
Appointment required (tick all that apply):

Blood tests must be taken before 4.00pm.

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

Cervical screening:

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.

Have you been told when to have the appointment, for example, "in the next two weeks" or "in one month's time"? *
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