Eden Villa Medical Practice > Forms > Appointment Request Form.

Appointment Request Form.

If possible, please provide a mobile number for us to contact you by text. We do not usually call to make appointments. Please make sure if you have requested an appointment to check your phone for a response.

This request form is available Monday to Friday, between 6:00am – 5:00pm (excluding public holidays and training afternoons) to collect details for one of our team to arrange an appointment, give advice, signpost to another service, arrange tests or ask for further information. If you have not heard from us in two days, please get back in contact.

Please note: Submitted forms are only viewed and processed during normal GP working hours.

eConsultation Form

Want to see online advice?

See advice and guidance on conditions, symptoms and treatments NHS Inform.

First make sure this is not an emergency

DO NOT use this form for any medical emergencies, as your request will not be seen immediately.

Important: Are you currently experiencing any of the following?

  • Signs of a heart attack – pain like a very tight band, heavy weight or squeezing in the centre of your chest or any pain that moves into your jaw or neck
  • Signs of a stroke – face drooping on one side, can’t hold both arms up, difficulty speaking, or weakness or numbness on one side of your body
  • Severe difficulty breathing – gasping, not being able to get words out, choking or lips turning blue
  • Heavy bleeding that won’t stop – uncontrollable bleeding from any part of your body
  • Severe injuries – including deep cuts after a serious accident
  • Poisoning – you have swallowed something you should not have (medicines, batteries, household chemicals
  • Seizure (fit) – someone is shaking or jerking because of a fit, or is unconscious (can’t be woken up)
  • Sudden, rapid swelling – of the eyes, lips, mouth, throat or tongue
Do you have any of the above symptoms? *
Please confirm you are a registered patient of this Practice

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