Ask the Patient Services a Question

You can use this form to ask the Patient Services a question. This could be a question about our services, how you can access our services, our website or any general queries you may have about the Practice. Your question will be passed to an appropriate member of staff for a response.

We aim to respond to all questions within 2-3 working days.

Please do not use this service for any urgent medical queries as this service is only monitored during practice working hours on a daily basis.

For Minor Illness issues please use our eConsult form – you will also find lots of information here also to self care or obtain care from your local pharmacist

Please note: If you have an urgent medical query you should telephone the surgery or contact the Out of Hours service by calling 111.

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Mobile Phone Number (preferable):

Home Phone Number:

Email Address: *

If you don't provide an email address we won't be able to respond to you by email

Named GP (if known):

Message: *

*

I confirm that my query is not a clinical query and that I acknowledge it could take up to 28 days for a reply

*

I confirm I am a registered patient at Montgomery House Surgery