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Alney Practice NHS GP Surgery in Gloucester

Get help for any health problem

This form is for non-urgent requests only

Please do not use this form if you need urgent help. For urgent medical advice, please call the surgery directly.

If you need help when the surgery is closed, visit NHS 111 Online or call 111. In a medical emergency, call 999.

About the Patient’s Problem

What is the reason for your query today? *

Is this a new problem or is this something that you have been in to see us about before? *

Is there anything else that you want to say about that problem? *

When did it start? *

If you’re not sure, it’s helpful to tell us whether it’s been days, weeks, months or years.

Have you tried anything to help with this problem already (self help, over the counter medication, pharmacy etc)? *

How long have you tried that for?

Has this changed at all since you last came to see us about it? (better/worse/same/not applicable) *

Is there anything specific that you were hoping to get from contacting us today? (GP review, treatment, a referral for further care, medication review, nurse appointment etc.)

Further questions

Do you use any of the following mobility aids?

Wheelchair

Walker

Cane

Other

None

Please specify: *

Video Consultation

I am willing to accept a video consultation

Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over WiFi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it’s best if you can receive your emails on that same device.

Do you need an interpreter? *

Yes

No

Which language do you need? *

The practice may contact you between 8am and 6:30pm during our opening hours.

We will most likely reply by email, but we may also phone or send a text message.

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.

I understand that this may take up to 1 working day for a GP to contact me, depending on which practitioner I request to speak to.

If you think it would be helpful, please upload photo(s) of your condition.

Maximum upload size: 8.39MB

If you are human, leave this field blank.

Cheltenham Road Surgery
16 Cheltenham Road
Gloucester
GL2 0LS

Get directions

01452 522709

Highnam Surgery
Lassington Lane
Highnam
GL2 8DH

Get directions

01452 529699

Register with the surgery

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