This form is to be used for a pre-booked consultation with a clinician who has requested this information
If you need urgent medical care call 999.
If you are unsure please click here for information on the NHS 111 service
Please note this form is NOT for emergency contact, medical concerns or appointment bookings.
Under no circumstances should you raise personal and confidential medical queries, including repeat prescriptions or appointment requests on this form.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Rowan Tree Practice
Former Weybridge Hospital Site, 22 Church Street, Weybridge, Surrey, KT13 8DW.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.