Online Consultation with a Nurse

Use this form at any time to get help from your practice. We aim to respond on the same working day.

If you are human, leave this field blank.

Section

About the Patient's Problem

Please tell us about the problem. If the practice is already aware of this problem, please tell us what has changed.

Do you have any ideas about what is causing the problem? (Optional)

What are the concerns? (Optional)

How would you like us to help? (Optional)

Please list any times when you would not be available:

Is there a member of staff who would be best to deal with this problem?

We cannot guarantee that your query will be passed onto the Clinician you have requested, this is dependent on their availability.

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

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

Terms & Conditions *

I confirm that this problem is not an emergency. I understand that the practice will not deal with this problem while the practice is closed.

If the problem worsens and may require immediate help, I will visit NHS 111 Online or call 111. In an emergency I will call 999.

Any message submitted after 16:00 will not be seen until the next working day. If your message needs a reply before this, then you must phone the practice on 020 8670 6878 instead.

I have read and understood the above statement.

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