Healthcare Assistant Appointment Request Form

How to Use This Form

Ensure that you complete all steps of this form to successfully send us a Healthcare Assistant appointment request. Please note that this form is for pre-bookable Healthcare Assistant appointments ONLY. Requests made on behalf of someone over the age of 18 years must ONLY be submitted if we have received written consent that you are allowed to do so. If this has not yet been done, please bring Signed Consent into the practice to be checked.

Please note that this facility is ONLY for requesting a Healthcare Assistant appointment, and is ONLY for patients who are registered with our practice. You should contact the surgery for any other requests.

You will also receive a notification email to your inbox confirming that the request has been sent successfully. If you do not receive a confirmation, please check your Junk or Spam email folders before contacting the Practice.

Step 1: Personal Details

Please provide your personal details below so we can identify you on our system. You must complete all fields marked with *. Click next to proceed to the next step.

Is this request submitted for yourself or someone you care for? *On behalf of myselfOn behalf of someone I care for and confirm the practice already has written consent for this

Note:

The Practice must have received written consent to discuss any patient's medical needs who are over 18 years of age.

Your Forename *

Your Surname *

Your Email Address *

Your Date of Birth *

Your Mobile Phone Number *

This mobile phone number will be used to send you a confirmation SMS text message.

Patient's Full Name *

Patient's Date of Birth *

Patient's Mobile Phone Number *

This mobile phone number will be used to send the patient a confirmation SMS text message.

Step 2: Type of Appointment

Please select the appointment type required from the list below. Please note that you may be required to complete additional information depending on the type of appointment you choose. You must complete all fields marked with a *. Click Next to proceed to the next step.

Appointment Type *Blood Pressure CheckBlood Test & Blood Pressure CheckBlood TestECGB12 VaccineSpirometryINR

Who has asked you to have this blood test? *GP/NurseHospitalAnnual ReviewOther

Do you already have your blood form? *YesNo

Preferred Appointment Time (please note that bloods are morning only) *MorningAfternoonAnytime

Which Practice would you like this appointment at? (please note you may get an earlier appointment date if you select Either Site) *Llanedeyrn OnlyLlanrumney OnlyEither Site

Please provide us with any other information that will help us book this specific appointment

Step 3: Finish & Confirm

To submit your Healthcare Assistant Appointment request, please click the Submit Request to My GP button. You will also need to consent to our GDPR policy.

GDPR Consent *

I agree to Llan Healthcare processing the personal information in this request and have read and accepted the terms of our privacy policy.

Please do not fill in this field.

Security

Our Healthcare Assistant appointment request form is encrypted and secured by a 128bit SSL certificate, and sends your request information in the content of an email. Although this is sent ONLY to the Practice, we are unable to guarantee complete privacy during the transmission.

If you have any concerns with regards to using this service, please speak to the Practice about other methods of requesting an appointment with the Healthcare Assistant.

What is GDPR?

The EU General Data Protection Regulation (GDPR) is the most important change in data privacy regulation in 20 years. GDPR fundamentally reshapes the way in which data is handled across every sector, from healthcare to banking and beyond.As part of our data privacy obligations, we have to ensure that when we collect information about you that we are fully compliant with GDPR. For more information, please see the Guide to the General Data Protection Regulation (GDPR) article on the ICO website .

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Llanrumney Medical Centre

Ball Road
Llanrumney
CARDIFF
CF3 5NP

Phone: 029 2079 2661

For information about Cosmetic Procedures, including Lip Fillers Cardiff and Anti-Wrinkle Treatments, see our Cosmetic Procedures page.

Wellbeing Hub @ Maelfa

Maelfa
Llanedeyrn
CARDIFF
CF23 9PN

Phone: 029 2073 1671

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Wellbeing Hub @ Maelfa: 029 2073 1671  Llanrumney MC: 029 2079 2661