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New Adult / Child Medical Problem Form

This service is for non-emergency queries only.
Call 999 now or visit your local A&E if you have:

Signs of a heart attack

Pain like a very tight band, heavy weight or squeezing in the centre of your chest

Severe difficulty breathing

Gasping, not being able to get words out, choking or lips turning blue

Severe injuries

Or deep cuts after a serious accident

Signs of a stroke

Face drooping on one side, can’t hold both arms up, difficulty speaking

Heavy bleeding

That won’t stop

Seizure (fit)

someone is shaking or jerking because of a fit, or is unconscious (can’t be woken up)

If you have none of these:

Please complete this form if you require an appointment with our a member of our clinical team.

Before you start

  • Your GP practice will aim to respond to your query within 2 working days.
  • If your query is not submitted, no details will be sent to your GP.
  • You must be over 16 to use this service, although you may use this service to contact the practice about a person you care for who is under 16.
  • You must be registered as a patient with Victoria Park Health Centre.
  • You must be currently living in the UK.

This form is currently closed for entries. If your symptoms require urgent assistance please contact NHS 111.