Long term condition synchronisation

Use this service to synchronise your long term condition appointments to save you extra trips to the surgery.

You can use this service if you:

Before you start

We’ll ask you for:

your first and last name, date of birth, sex, postcode, email and phone number
if applicable, the details of the person you are completing the form on behalf of

You can also phone us on 0118 969 0160.

Who are you completing this form for?For example, on behalf of a child or dependent

Yourself

Someone else

What is your name?

First name Last name

What is your date of birth?For example, 31 3 1980

What is your sex?As recorded on your medical record

Male Optional

Female Optional

Other Optional

What is your postcode?The one used to register with your GP

ZIP / Postal Code

What is your phone number?

What is your email address?Anyone else with access to your email account may see responses sent to you

Named GP (if known): Optional

Which conditions have you been diagnosed with? Optional