Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Skip to main content

Ailsa Craig Medical Practice NHS GP Surgery in Manchester

Request an appointment with a nurse or healthcare assistant

Request an appointment with a Nurse or Healthcare Assistant

Required fields are labelled

You must be aged 13 or over to complete this form yourself

Who are you completing this form for? Required

For example, on behalf of a child or dependent

Yourself

Someone else

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

The practice can send a text message to your phone with your appointment time. Required

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

Appointment required (tick all that apply):

Blood test

Blood pressure check

ECG

Vaccination

Asthma review

COPD review

Diabetes review

Diabetic foot check-up

Cervical screening

Other

Blood tests must be taken before 1.00pm.

You can also book blood tests directly using the NHS App or Patient Access.

Cervical screening:

I know that cervical screening is due now.

I am not sure when cervical screening is due. Please check records.

Please specify what other appointment:

Have you been told when to have the appointment, for example, “in the next two weeks” or “in one month’s time”? Required

Yes

No

When does the appointment need to be?

Tell us when you are available to have an appointment:

Tell us when you are available to have an appointment in the next three weeks:

Do you need an interpreter?

Yes

No

Which language do you need?

Please select to confirm that you understand Required

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

Please upload any relevant evidence in relation to this request.

Do not upload sensitive photographs of genitalia, bottoms (anus), breasts or minors without asking a healthcare professional first. Your uploads may be stored on your health record.

If you are human, leave this field blank.