Online Forms

Quote / Testimonial:

In this section you will find a library of useful forms to use for day-to-day medical requests. If you need further help or assistance please contact us at the surgery.


Prescription Questions

Pharmacists are trained experts in the use of medicines. For many questions regarding your medication you’ll find your pharmacy a valuable source of information.

Repeat Prescription Request

An NHS repeat prescription is an instruction by your doctor to prescribe the medication you need to treat a specific medication condition on a regular basis.

Synchronising Prescriptions

If you would like to save time and order all the medication you have on repeat at the same time rather than irregular times throughout the month please use this form.

Health Reviews

Asthma Review

If you have been advised by the surgery to submit an annual review of your asthma symptoms please use the form below. If your symptoms are deteriorating or you are having any concerns please make an appointment with our Nurse.

Oral Contraceptive Pill Check

If you have been advised by the surgery to submit a review of your Oral Contraceptive Pill, please use the form below. If you are having any concerns please make an appointment with our Nurse.

Blood Pressure Review

If you have been advised by the surgery to submit your blood pressure readings on a regular basis please use this form.

NHS Healthcheck

If you have received a letter from the surgery inviting you for a free NHS Health Check please use this form. We do need to know your height, weight and blood pressure.

Tests and Results

Request my Test Results

You can use this form to request your test results. We aim to respond to all questions within two working days.

GP sick notes

GP sick note for more than 7 days

If you have been ill for more than 7 days you will need a doctor’s certificate. These certificates are called ‘Fitness To Work’ Certificates.

Requesting an additional sick note

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note.


Travel Assessment

Our practice is no longer providing private travel vaccines to our patients (or temporary visitors to the area).  However, we continue to offer appointments for travel vaccine advice and will also provide the free NHS travel vaccines.

Patient Information

New Patient Registration

You can now register as a patient using our online services. Simply complete our New Patient Registration Form Online below.

Please be aware that you will need to upload valid photographic ID to complete this registration.

Register for Online Services

By registering for SystmOnline you will be able to view your electronic medical record as well as appointment management or ordering repeat prescriptions.

Change your details

If you move house it is important that you let us know your new address. It is also important that we have an up-to-date contact telephone number for you at all times.

Temporary Resident

The Temporary Resident form will need to be completed when you are visiting Rutland for a short period but require medical treatment by the local Surgery.

Please ensure you have made contact with the Surgery in the first instance before completing the form.

Register a carer

It is important that we know if you are a carer so that we can make sure you receive information, services and the help that is available. If you are a carer please complete this form

Cancel your appointment

It is important to cancel your appointment if you can not make it or no longer need it, this then gives more availability to patients who may need to be been urgently.

Contact the surgery

Provide your Feedback

We would like you to think of your recent experiences of our services.

Summary Care Record Preference

Summary Care Record Opt Out Form Your Summary Care Record contains important information from the record held by your GP practice and includes details of any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced.

Ask the practice a non-clinical question

You can use this form to ask the Practice a non-clinical 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.

NHS Friends & Family Test

Did you know you can now have your say to help improve more services across the NHS? The Friends & Family Test is about giving patients the opportunity to provide quick feedback on their care and treatment experience.

Comments, Complaints, and Suggestions

Your comments and suggestions are welcome to improve the quality of our service.