Please complete this questionnaire if you wish your symptoms be assessed by your GP Surgery. This service is only provided on Monday to Friday, 8.30am to 6.30pm.
To find out more about your symptoms or condition, please visit www.nhs.uk/Conditions
When you are happy with your answers, click 'Submit Form' below to send the questionnaire to your GP Practice. Your GP Practice will then assess your answers and will contact you with the appropriate follow-up advice. If you have not heard anything after 48 hours, please phone your GP Practice directly.
Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to Swanage Medical Practice • Station Approach, Swanage, Dorset, BH19 1HB.
Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.
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