For urgent help, contact your GP. If they are closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

If you need more urgent help, call your GP practice. If it's closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

What would you like help with?

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I have a health problem

Medical request

# Add information about the health problem

**Your request will be reviewed by a member of the team during surgery opening hours. Medical and appointment requests can be submitted from 6.30am Monday to Friday (excluding bank holidays). We have extended our Medical Request form capacity, however we cannot guarantee same day appointments for all request we receive. All request will be reviewed by our Triage clinician who will advise on the appropriate action.**

If you need more urgent help, call your GP practice. If it's closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

Focus on one, for example: I have a pain in my lower back

For example: It's been going on for over a week

How long has it been going on for? Is it getting better or worse?

Enter whether you've tried anything to help

For example: I've tried physio, which helps a little

For example: I'm worried about it affecting my work

Is there anything you're particularly worried about?

For example: I would like help managing my pain

We can't guarantee a time and will only contact you during opening hours

Patient information