Online Consultation Request Form

PLEASE DO NOT USE THIS FORM IN AN EMERGENCY

or call us on 0114 2396687

How to use this form

  • Do not use this form to order repeat medications. Register for Online Services instead.
  • The form will not be read by a doctor or nurse first.
  • Use this form to contact us about a medical problem rather than phoning our Reception.
  • Use this form to arrange a call back from the medical centre by the end of the next working day.
  • Your request will be sent to us securely and read by one of our admin staff, who will arrange the most appropriate plan.
  • We may need to call you with a plan or for more information, so please give us a working telephone number.
Gleadless Online Consultations Contact Form

For the form to appear, please tick here to confirm you have read the following link:

When to call 999

Who are you? *
This person must be a registered patient at Gleadless Medical Centre for us to respond to your request.
We will call back during practice opening hours by the end of the following working day. We DO NOT enter into email conversations.
This is only for us to contact you if we cannot get hold of you by telephone and if we feel we need to contact you.
Is the reason you’re contacting us related to a painful or stiff JOINT, MUSCLE or BACK problem? *

surprised New  Directly bookable Physiotherapy

If your problem is related to a painful or stiff JOINT or MUSCLE (such as your back), would you be happy to be booked first with our Physiotherapist for an expert assessment and treatment?

REMINDER If you feel your symptoms are urgent or life threatening then PLEASE DO NOT USE THIS FORM, call 999. You can also call 111 in less urgent situations or if you are not sure.

REMINDER If you feel your symptoms are urgent or life threatening then PLEASE DO NOT USE THIS FORM, call 999. You can also call 111 in less urgent situations or if you are not sure.


Would you like to upload pictures or other files to help us understand your enquiry?
If you think it would help us understand your enquiry you can upload files such as photos or documents here
Maximum upload size: 5MB
This may be an image or a document. By sending this file you accept full responsibility for the lawful transmission of electronic information.
I confirm that I understand ALL of the following statements: *

Page last reviewed: 05 August 2020