Locum request form
Please complete this form to request a locum.
Name of Practice
What type of locum do you require
Virtual GP
Onsite GP
Virtual NP
Onsite NP
Other
Is the practice registered with Remedi?
Yes
No
Please register with Remedi by clicking on the button below
Consultation / Sessional cover
Use the drop down boxes in the table below to select the type of sessional cover you require for each day. Leave the session blank if you don't need cover at that time. If you are looking for a locum to cover the same shifts each week, fill in the week as a template and then choose your start and finish dates.
What date do you need a locum to start?
-
Day
-
Month
Year
Morning Session
Afternoon Session
Out of hours sessions
Monday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Tuesday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Wednesday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Thursday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Friday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Saturday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Sunday
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
Telephone Consults
Video Consults
GP Triage
Onsite
What date do you want the locum to finish?
-
Day
-
Month
Year
What are your practice session times?
Morning Session
Afternoon Session
Out of Hours session
Session times
Inbox and Repeat Prescription requests
Use the boxes below to select the days you require a locum to cover inbox and repeat prescription requests. Select 'None' if no cover is required.
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
None
Repeat Prescriptions and inbox cover
Special requirements / Other information
Please enter details of special requirements or other information in the box below.
Contact details
Who should we contact at the practice if we have any questions about this booking?
Contact Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Request a locum
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