Book a Locum

Book a Locum

Please complete this form to request a locum.
Name of Practice
What type of locum do you require

Virtual Clinician (consultations)Onsite Clinician (consultations)Inbox/Scripts/Tasks (non-contact medicine)Other
Is the practice registered with Remedi?

YesNo
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. .
Start date

DayMonthYear
What date do you need the locum to start?
Finish date

DayMonthYear
Date of the last day the locum is required

Inbox and Repeat Prescription processing

Use the boxes below to select the days you require a locum to cover inbox and repeat prescription requests. Then complete the number hours per day required.
Start date

DayMonthYear
What date do you need the locum to start?
Finish date

DayMonthYear
Date of the last day the locum is required

	Morning Session	Afternoon Session	Out of Hours session
Session times

Days that Inbox cover is required

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Repeat Prescriptions and inbox cover

How many hours per day for inbox cover?

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
How many hours are required per day

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 address
example@example.com
Phone Number

Area CodePhone Number
Should be Empty:

Consultation / Sessional cover