Pre-consultation: GP Consultations

First name *

Last name *

Email *

Phone *

Date of birth *

Primary reason (select all that apply): *

New symptom

Ongoing condition review

Medication review

Second opinion

Referral request

Sick note

Travel certificate

General health advice

Mental health

Other

How long have you had this symptom?

Less than 1 week

1-2 weeks

2-4 weeks

More than 1 month

Severity:

Mild

Moderate

Severe

Very severe

What makes it better or worse?

Have you seen anyone else about this (GP, A&E, urgent care)?

No

Yes - NHS GP

Yes - A&E

Yes - Urgent care

Yes - Other

What condition(s) are you being treated for?

Current treatment for this condition:

How well is the current treatment working?

Excellent control

Good control

Fair control

Poor control

What has changed (if anything)?

List your current medications:

Are you experiencing any side effects?

No

Minor side effects

Significant side effects

Very troublesome

Are you taking medications as prescribed?

Yes, all as prescribed

Mostly as prescribed

Occasional missed doses

Not as prescribed

Known medication allergies or intolerances:

Other allergies (foods, environmental, latex):

Major medical history (conditions/surgeries):

Are you registered with an NHS GP? *

We encourage patients to be registered with both LoveMyLife and an NHS GP - you get the benefits of both

Yes

No

Not sure

Any recent NHS investigations, blood tests, or hospital visits?

No

Yes

Any significant family history (genetic or chronic conditions)?

Smoking status:

Never smoked

Ex-smoker

Current smoker

Alcohol consumption per week (units):

Exercise frequency:

None

1-2 sessions per week

3-4 sessions per week

5+ sessions per week

How would you prefer to be seen? *

Face to face

Video

Phone

Anything else we should know?

Here's what you've told us. Have a quick check, then hit send - this means your consultation can focus on what actually matters to you.

Your details

Name

Email

Phone

Date of birth

Why are you seeing us today?

Primary reason (select all that apply): -

If new symptom...

How long have you had this symptom? -

Severity: -

What makes it better or worse? -

Have you seen anyone else about this (GP, A&E, urgent care)? -

If ongoing condition review...

What condition(s) are you being treated for? -

Current treatment for this condition: -

How well is the current treatment working? -

What has changed (if anything)? -

If medication review...

List your current medications: -

Are you experiencing any side effects? -

Are you taking medications as prescribed? -

Allergies & Medical History

Known medication allergies or intolerances: -

Other allergies (foods, environmental, latex): -

Major medical history (conditions/surgeries): -

NHS GP Registration

Are you registered with an NHS GP? -

Recent Health Investigations

Any recent NHS investigations, blood tests, or hospital visits? -

Family History

Any significant family history (genetic or chronic conditions)? -

Lifestyle

Smoking status: -

Alcohol consumption per week (units): -

Exercise frequency: -

Your Consultation

How would you prefer to be seen? -

Anything else we should know? -

Upload recent test results, referral letters, or medical records

Optional: PDF or image files, max 10MB each

Click to upload files

Anything else for your doctor?