1 Carterknowle Road, Sheffield, S7 2DW

Telephone: 0114 229 1686

Sorry, we're currently closed. Please call NHS 111

See our other Locations

137 Dore Road, Dore, Sheffield, S17 3NF | Telephone: 0114 229 1686

Twitter Link
Facebook Link

Home
Practice Info
Patient Services and Information
Request a Routine Appointment
Job Vacancies
Cancel an Appointment

Outsmart your anxiety – Daylight Respiratory Syncytial Virus (RSV) Vaccination Information Support for people who may have been affected by infected blood Travel Vaccinations – Cholera Vaccine Supply Issues MMR (measles, mumps and rubella) Vaccination Campaign Return your used inhalers to a pharmacy to help reduce your carbon footprint Social Prescribers & First Contact Physiotherapists Sheffield is full of welcoming, warm places Working Win South Yorkshire Chaplaincy & Listening Service

Home
Brief routine appointment request

Brief routine appointment request

Brief Routine online request form – Blood tests, smear test, B12, child immunisations, ear syringing

Please note this form is for routine simple requests, such as requesting an appointment for a smear test or a blood test. You cannot use this form to request your own bloods, please only use this form if the blood test you require has been requested by a clinician or is a repeat test that is due. Please do not use this form if you are unwell, as this form will not triage your symptoms appropriately.

Name(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Email(Required)

Phone Number(Required)

If you are not the patient above but are completing it on their behalf please give us your name and phone number should we need to speak to you?

Consent(Required)

I confirm I have read the below statement and my enquiry is not urgent(Required)

I confirm I am not reporting an acute infective illness that may require more prompt medical treatment such as urine infections, chest infections, tonsilitis, scarlet fever or illnesses where clinical response is needed urgently (Forms can take up to two working days to be seen and runs the risk that the condition is not treated in a timely manner. If your enquiry is relating to an infection or acute illness, this should be phoned through that day or advice sought from the walk-in-centre or 111 / GP out of hours services if we are closed).

Consent(Required)

I consent to the practice collecting and storing my data from this form.(Required)

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.

There is also availability on a Saturday day time, or evening (Mon-Fri 18:30-21:30pm), would you be happy if we arranged an appointment during these times?(Required)

Yes

No

Our team will arrange an appointment on your behalf and text you to let you know when it is. Please advise your availability below. Many people want appointments at similar times so the more options you give us the sooner the date we can book the appointment for.(Required)

Monday Mornings

Monday Afternoons

Tuesday Mornings

Tuesday Afternoons

Wednesday Mornings

Wednesday Afternoons

Thursday Mornings

Thursday Afternoons

Friday Mornings

Friday Afternoons

Evening Appointment Monday – Friday 18:30 – 21:30 (Carterknowle Surgery Only)

Saturday Mornings (Carterknowle Surgery)

Saturday Afternoons (Carterknowle Surgery)

What appointment is it you require?(Required)

Smear Test (cervical screening)

MMR Vaccination

B12 Injection (I bring my own injection)

B12 Injection (I require an injection from the surgery)

Childhood immunisations

Blood test (Please note, we cannot book bloods that you have requested yourself, we can only book you in if a clinician has requested them beforehand).

Ear Syringing (I have had this done before)

Ear Syringing (I have have not had this done before)

If it is a blood test appointment that you require, please provide details of which clinician requested the bloods below.

You can also advise our team if the test is a fasting blood test or any other relevant details.

Phone

This field is for validation purposes and should be left unchanged.

45342

Zero Tolerance

Veteran Friendly

Carterknowle Surgery
Opening Times

Monday
08:30am to 12:30pm
01:30pm to 06:00pm
Phone lines close at 12:15 and reopen at 13:30
Tuesday
08:30am to 12:30pm
01:30pm to 06:00pm
Phone lines close at 12:15 and reopen at 13:30
Wednesday
08:30am to 12:30pm
01:30pm to 06:00pm
Phone lines close at 12:15 and reopen at 13:30
Thursday
08:30am to 12:30pm
01:30pm to 06:00pm
Phone lines close at 12:15 and reopen at 13:30
Friday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Saturday
CLOSED
Sunday
CLOSED

Dore Surgery
Opening Times

Monday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Tuesday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Wednesday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Thursday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Friday
08:30am to 12:30pm
01:30pm to 05:00pm
Phone lines close at 12:15 and reopen at 13:30
Saturday
CLOSED
Sunday
CLOSED

Useful Links

NHS Choices

NHS 111

Patient UK

Cervical Smears

NHS A-Z Conditions

Find Local Services

Live Well

Twitter Link
Facebook Link

Staff Login | Privacy Policy | Accessibility

Accessibility Tools

Update your details

"*" indicates required fields

Personal Details

Name*

First Last

Date of Birth*

Email Address*

Ethnicity*

CHANGE OF NAME

Previous surname

Please note we cannot change your name without a change of name document. This can be marriage certificate, deed poll etc. Our team will be in touch to ask you for this if you have requested to change your name.

How do you wish to be known?

Dr

Mrs

Mr

Miss

Ms

Other

CHANGE OF ADDRESS

Previous Address, including postcode

New Address, including postcode

Please list all family members moving with you

UPDATE CONTACT NUMBERS

Do you consent to being reminded by text for appointments?

Yes

No

Are you a carer?*

Yes, I am a carer for a friend/relative

Yes, I work as a carer in a residential/care home or community setting

No

Number Type

New Phone Number

Email

This field is for validation purposes and should be left unchanged.

51223

Cleantalk Pixel

Cookies To make this site work properly, we sometimes place small data files called cookies on your device. Most big websites do this too.

Accept

Read more

Change Settings

Cookie Box Settings

Cookie Box Settings

Privacy settings

Decide which cookies you want to allow. You can change these settings at any time. However, this can result in some functions no longer being available. For information on deleting the cookies, please consult your browser’s help function. Learn more about the cookies we use.

With the slider, you can enable or disable different types of cookies:

Block all
Essentials
Functionality
Analytics
Advertising

This website will:

Essential: Remember your cookie permission setting
Essential: Allow session cookies
Essential: Gather information you input into a contact forms, newsletter and other forms across all pages
Essential: Keep track of what you input in a shopping cart
Essential: Authenticate that you are logged into your user account
Essential: Remember language version you selected

This website won't:

Remember your login details
Functionality: Remember social media settings
Functionality: Remember selected region and country
Analytics: Keep track of your visited pages and interaction taken
Analytics: Keep track about your location and region based on your IP number
Analytics: Keep track of the time spent on each page
Analytics: Increase the data quality of the statistics functions
Advertising: Tailor information and advertising to your interests based on e.g. the content you have visited before. (Currently we do not use targeting or targeting cookies.
Advertising: Gather personally identifiable information such as name and location

This website will:

Essential: Remember your cookie permission setting
Essential: Allow session cookies
Essential: Gather information you input into a contact forms, newsletter and other forms across all pages
Essential: Keep track of what you input in a shopping cart
Essential: Authenticate that you are logged into your user account
Essential: Remember language version you selected
Functionality: Remember social media settings
Functionality: Remember selected region and country

This website won't:

Remember your login details
Analytics: Keep track of your visited pages and interaction taken
Analytics: Keep track about your location and region based on your IP number
Analytics: Keep track of the time spent on each page
Analytics: Increase the data quality of the statistics functions
Advertising: Tailor information and advertising to your interests based on e.g. the content you have visited before. (Currently we do not use targeting or targeting cookies.
Advertising: Gather personally identifiable information such as name and location

This website will:

Essential: Remember your cookie permission setting
Essential: Allow session cookies
Essential: Gather information you input into a contact forms, newsletter and other forms across all pages
Essential: Keep track of what you input in a shopping cart
Essential: Authenticate that you are logged into your user account
Essential: Remember language version you selected
Functionality: Remember social media settings
Functionality: Remember selected region and country
Analytics: Keep track of your visited pages and interaction taken
Analytics: Keep track about your location and region based on your IP number
Analytics: Keep track of the time spent on each page
Analytics: Increase the data quality of the statistics functions

This website won't:

Remember your login details
Advertising: Use information for tailored advertising with third parties
Advertising: Allow you to connect to social sites
Advertising: Identify device you are using
Advertising: Gather personally identifiable information such as name and location

This website will:

Essential: Remember your cookie permission setting
Essential: Allow session cookies
Essential: Gather information you input into a contact forms, newsletter and other forms across all pages
Essential: Keep track of what you input in a shopping cart
Essential: Authenticate that you are logged into your user account
Essential: Remember language version you selected
Functionality: Remember social media settings
Functionality: Remember selected region and country
Analytics: Keep track of your visited pages and interaction taken
Analytics: Keep track about your location and region based on your IP number
Analytics: Keep track of the time spent on each page
Analytics: Increase the data quality of the statistics functions
Advertising: Use information for tailored advertising with third parties
Advertising: Allow you to connect to social sitesl Advertising: Identify device you are using
Advertising: Gather personally identifiable information such as name and location

This website won't:

Remember your login details

Save & Close