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Springfield Medical Centre NHS GP Surgery in Eccles

Routine get help for any health problem

Consent for sending health information via email *

Confirmation of consent for information about your/the patient’s health to be sent to the email address provided

About the Patient’s Problem

Please tell us about the problem. If the practice is already aware of this problem, please tell us what has changed. *

How long has this been a problem? *

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

Do you have any ideas about what is causing the problem? *

What are the concerns? *

How would you like us to help? *

Do you need extra communication support e.g. an interpreter?

Yes

Please specify the support you require: *

How would you like us to deal with the problem? *

Online message sent through your email

Telephone

Face to face appointment

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 and may take up to 5 days to respond.

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.

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

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384 Liverpool Road
Eccles
Manchester
M30 8QD

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0161 871 2450

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