Request an Appointment with a Nurse – OneContact Patient Portal

Identification Questions

In order to identify patients correctly, we would like you to answer the following questions.

Identification Questions

In order to identify patients correctly, we would like you to answer the following questions.

If you have an NHS login, use it now and save time on filling in some details.

Are you the patient? *

Yes

No

Additional information

Please could you give us your own details first and then provide the patients details

Your First Name *

Your Last Name *

Your Address *

Relationship to patient *

Date of birth *

Now can you enter the patients details:

First Name *

Last Name *

Gender *

Male

Female

Other

Please elaborate: *

Date of birth *

First line of address *

Postcode *

Preferred contact: *

Email

Landline

Mobile

Preferred contact:

Mobile

Landline

Letter

Phone *

Email *

Please note that the sick note will be sent via email.

Appointment required (tick all that apply)

ECG

Adult Vaccination/Injection

Wound Management/dressing

Cervical screening

Please specify why you require the ECG

Please specify which vaccine is needed

B12

Pneumococcal

Shingles

RSV (Respiratory syncytial virus)

Goserelin (LHRH agonist – Hormone therapy for prostate cancer)

Travel

Please specify when it is due

Have you been invited to have the vaccine?

Yes

No

We will check your records to confirm that you are due this vaccine. Please note that if you are not eligible, we will not be able to offer you an appointment.

Please specify when it is due

We do not offer a travel clinic at the surgery but are able to offer the following vaccines under the NHS:

Hepatitis A
Typhoid
Diphtheria/Tetanus/Polio

These appointments must be booked 4 weeks in advance with the practice nurse to ensure timely order and delivery of the vaccine. We are unable to accommodate any requests less than 4 weeks and you may be directed to a private travel clinic.

Please look at the following useful resource to check what vaccinations and precautions including malaria prophylaxis you may need for safe travel

www.fitfortravel.nhs.uk/home

If malaria prevention treatment is recommended then you should consult with your local pharmacy or a private travel clinic including vaccination for yellow fever or rabies.

Please specify the date and destination of your travel

If you have an infected and/or painful wound which requires urgent care contact the surgery on 0208 863 3333 or call 111.

Please specify

New wound

Post-operative wound/dressing

Followup dressing

Please specify when the dressing/stitches removal is due

Have you received an invitation to have your smear?

Yes

No

The smear needs to be done mid-cycle, i.e. 10 to 20 days from the 1^st day of your period. If you do not have regular periods, the appointment can be booked for any time.

Please specify when the smear is due

Are you eligible for an annual smear?

Yes

No

Please specify the reason

The smear needs to be done mid-cycle, i.e. 10 to 20 days from the 1^st day of your period. If you do not have regular periods, the appointment can be booked for any time.

Please specify when the smear is due

If you have not been invited and/or are not eligible for a smear, we will not be able to offer an appointment.

Consent

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

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