Appointments

Request an appointment

Complete the appointment request form with parent and child details. The practice will contact you about availability and next steps.

When is it urgent?

General urgency guidance

This tool is not diagnostic. Select any option that sounds relevant to see the safest next administrative step.

Select an option above. Urgent symptoms should always be handled through emergency care, not website forms.

Appointment request form

Use this placeholder form only for non-urgent appointment administration. Do not use it for emergency symptoms or detailed clinical histories until a secure practice-approved submission service is connected.

Prototype placeholder only. Do not collect or rely on patient information through this form until it is connected to a secure, encrypted, practice-approved submission service.

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Parent/guardian details
Child details
Appointment details
Medical details
Consent

Leave this field blank

Parent/guardian detailsSection 1 of 5

Parent/guardian first name*

Parent/guardian surname*

Relationship to child*

Mobile number*

Email address*

Preferred contact method*

Child detailsSection 2 of 5

Child first name*

Child surname*

Date of birth*

Gender*

Appointment detailsSection 3 of 5

Reason for appointment*

Brief description of concern*

Has the child been referred by a doctor?*

Referring doctor name

Has the child seen this practice before?*

Preferred appointment type*

Preferred dates or times

Medical detailsSection 4 of 5

Current medication

Known allergies

Previous tests or reports

Additional notes

ConsentSection 5 of 5

I consent to the practice processing the submitted information for appointment administration.

I understand this form is not for emergencies.

This website provides general information and is not for emergencies. If your child is acutely unwell, has a prolonged seizure, breathing difficulty, reduced responsiveness, or any medical emergency, please go to the nearest emergency department immediately.

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