Required field(s) are indicated by * Ask Reception a Question (COVID-19) If you are human, leave this field blank. COVID-19 Screening Do you have either: a high temperature - This means you feel hot to touch on your chest or back (you do not need to measure your temperature) * Yes No a new, continuous cough - This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual) * Yes No loss or change to your sense of smell or taste - this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal * Yes No Have you been told by 111 to contact the practice? * Yes No Do you live with someone who has had a high temperature or a new, continuous cough? If their symptoms started more than 14 days ago, click No. * Yes No Please continue to fill out this form Your symptoms suggest you might have Coronavirus (COVID-19). You should use the 111 online coronavirus service to find out what to do. Please do not use this form for any clinical enquiries. If you would like to consult a clinician, please use our Get Help for any Health Problem form. You have not agreed to share your data with this website, please either try to login again and grant the website access or alternatively fill out the form below. To proceed, you can either use NHS login, which will retrieve your details and will pre-populate the form below: Continue to NHS login or continue without NHS login and complete the form below: About you Your First Name(s): * As it appears on your passport. Your Last Name: * As it appears on your passport. Postcode: * The one used to register with your GP. Your Date of Birth: * Your date of birth is required to verify your identity. Sex: * Male Female Other As on your medical record. As on your medical record. Your Phone Number: * This phone number will be used for all correspondence relating to this request. Your Email: * This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you. We will send you an acknowledgment on receipt of your request and a notification when a reply is ready. How would you like to receive these notifications? * By Text Message By Email By both Text Message and Email Please continue completing the form below Your question: * I confirm that my enquiry is not urgent, and it may take up to 2 working days before I receive a reply. Submit