be well | appointments

Appointment booker

Use this form to request a weekday appointment at least 2 working days from now, (selected medical centres only). For urgent requests please call your medical centre directly. In an emergency dial 111. Please follow guidelines for input on the right of the screen. * = required field
First name (*)
Please enter your first name
Last name (*)
Please enter your last name
Birth date (*)
Please enter your birth date: DD/MM/YYYY		 Please use this format: DD/MM/YYYY
Phone (*)
Invalid input - use numbers only, no gaps, eg 091234567		 A DAYTIME number we can call you on.
Cell phone
Invalid input - use numbers only, no gaps		 Please add your cellphone number if you have one.
Email (*)
Invalid Input
My Medical centre (*)
Please select your medical centre.		 We regret this service is no longer available for St Lukes Medical Centre.
My GP
Invalid Input		 Please enter the name of your usual GP, or leave blank if you don't mind which doctor you see.
Appointment date (*)
Please choose a date 2 working days or more from now		 Appointments may ONLY be requested 2 WORKING DAYS AND MORE from TODAY. For more urgent requests please call the medical centre directly.
Alternative dates
Invalid Input		 In case we cannot meet your first choice, please give us alternative appointment dates
Time (*)
Please select a time.		 Please select your preferred time of day. To select more than one, press 'Ctrl' and click on both.
Appointment purpose
Invalid Input		 This helps us ensure that the right amount of time is booked.
  

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