Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Skip to main content

Victoria and Five Elms Medical Centre NHS GP surgeries in Essex and Dagenham

Depression review follow up request

Depression review follow up request

Required fields are labelled

Who are you completing this form for? Required

For example, on behalf of a child or dependent

Yourself

Someone else

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

Which surgery are you registered at? Required

Victoria Medical Centre

Five Elms Medical Practice

Have you been offered a follow up appointment by the practice? Required

Yes

No

Terms and conditions Required

I confirm that I have had my first appointment with my GP. I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.

If you are human, leave this field blank.

Forms Unavailable

Our forms are currently closed. For medical assistance, please call NHS 111, or contact them online using the button below.

For medical emergencies only, please call 999

Victoria Medical Centre
1 Queens Road
Barking
Essex
IG11 8GD

Get directions

020 8477 8760

Five Elms Medical Practice
Five Elms Road
Dagenham
RM9 5TT

Get directions

0208 517 1175

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

This service is no longer registered with CQC

View this service's archived profile on the CQC website

Five Elms Medical Practice

CQC overall rating

Requires improvement

14 April 2020

See the report

© Silicon Practice

Accessibility statement

Website policies