Request a Non-Urgent GP Appointment

Please complete the form below to request a Non-Urgent GP Appointment.

Please note this form is for prebookable doctor appointments ONLY - visit our Admin Queries page for any non-clinical requests.

Check it's not an emergency

Call 111 or 999 for urgent medical help if you have any of these as your request will not be seen immediately.

Crushing chest pain and tightness
New drooping on one side of the face, slurred speech, difficulty raising your arms, weakness or numbness on one side of your body
Severe difficulty breathing
Heavy bleeding that won't stop
Severe injuries
Feeling suicidal, wanting to harm yourself, or others

Is this request submitted for yourself or for someone you care for? Please note the practice must have received written consent to discuss any patient medical needs who are over the age of 18+

On behalf of myself
On behalf of my child
On behalf of someone I care for and confirm the practice already has written consent for this.

Medical issue details

Please describe the medical problem. If you are filling this in on behalf of someone else, please make that clear

Attach a photo (Optional)

How long have these symptoms or concerns been going on? Have they got better or worse?

Is there anything you are particularly worried about? (Optional)

Please enter any times during opening hours when we cannot contact you (Optional). We will only contact you within practice opening hours

Patients First Name

Patients Last Name

Date of birth

Postcode

Your phone number. A mobile number is preferred

Bryntirion Surgery