Important: For care home use only

This form should only be completed by care home staff on behalf of their residents, who are registered patients of Wymondham Medical Partnership.

A member of our clinical team may call you to discuss the problem.

Where possible, home visit requests should be made before 10.30am.

If you are a patient or need to contact us directly, you can phone us on 01953 602220.

Care Home Request
Which care home does the patient belong to?

Section

Requester Details

About the Patient’s Problem

Is the problem about your medication? *
If you’re not sure, it’s helpful to tell us whether it’s been days, weeks, months or years.
How would you like us to deal with the problem? *

Online message sent through your email

Telephone

Face to face

Video Consultation
Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over wifi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it’s best if you can receive your emails on that same device.
How quickly do you think the problem needs to be dealt with? *
Terms & Conditions