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This form is for patients of Wickham Market Medical Centre and Rendlesham Surgery only. If you are not a patient of either of these practices please exit this form.

Please use this form for general enquiries and comments only.

Please do not use this for booking or cancelling appointments, requesting sick notes (med3 forms) or for the ordering of medication.

If you have a personal or other clinical query please contact reception and arrange an appointment or a telephone consultation with a doctor or nurse.

Thank you

Personal Details

Full Name: Date of Birth (patients only): Address: Postcode: Daytime Telephone Number: Mobile Telephone Number: Email Address:

Concern / Comment / Compliment

My query relates to: My message to the practice is:

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I confirm that I am a patient at Wickham Market Medical Centre or Rendlesham Surgery.

Information provided by you through this form will allow us to improve our services. The form data undergoes encryption during transmission and while at rest, and will only be retained for a duration sufficient to process your request. You have the option to withdraw your request at any time by notifying the practice. By using this form you are agreeing to our privacy guidelines.

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