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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 your local 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.

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.

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.

Tests and results

Contraceptive Pill Review

If you have been advised by the surgery to submit a contraceptive pill review, please use this form. When you are taking the contraceptive pill you need to have a review at least every 12 months. You may be due a review sooner if you have recently started or changed your contraceptive pill.

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 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.


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

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.

Patients have a responsibility to keep us informed of their current address and phone number so that we can keep in touch.

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

Contact the surgery

Provide your Feedback

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

Patient Participation Group Sign up

All registered patients are welcome to attend any meeting of the Patient Participation Group without giving prior notice. If you are interested in hearing about the activities of the Patient Participation Group but cannot/do not want to attend meetings please complete the form below to receive newsletters and invitations to contribute to the group activities online.

Ask the practice a non-clinical question

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