Bennfield Surgery
Bennfield Surgery
Bennfield Surgery
Bennfield Surgery 

Patient Forms and Information

Blood pressure readings


You may be asked to complete a diary of your blood pressure readings and submit it to the surgery. Below is a diary template and important information on taking your blood pressure readings. 


Please return your completed diary to the surgery either by:


                      Hilton House

                      Corporation Street


                      CV21 2DN

Blood Pressure Diary and Information
Blood Pressure Diary and Information.doc[...]
Microsoft Word document [26.2 KB]

Physiotherapy Self-Referral


You can refer yourself for musculoskeletal (only) physiotherapy. If your problem is not musculoskeletal, please book an appointment with your GP to discuss further. 


Referrals will not be accepted if the issue has already been treated with physiotherapy in the last 6 months. 


You can complete an online self-referral form by visiting the physiotherapy page, or by completing the form below.

Self Referral to Physiotherapy
Microsoft Word document [216.5 KB]

Patient Third Party Consent


You may wish to authorise a representative to speak to the practice on your behalf regarding your medical information.


In order to do this, we require you to complete and sign the form below and return it to the Surgery. 


This will allow your representative to communicate with us about your medical records/information. It will enable them to gain information about you and your medical problems, talk about your care, and give and receive information about you. This includes any unforeseen new medical information. 


The consent does not allow your representative to gain copies of your medical records, sign any consent forms on your behalf, withdraw your care or sign an order to prevent your resuscitation. 

Patient Third Party Consent form
Patient third party consent form - April[...]
pub File [103.0 KB]

How to contact us

Bennfield Surgery

Hilton House

Corporation Street


CV21 2DN


Tel: 01788 540860


Opening hours: 

Monday-Friday, 08:30am - 06.00pm


Saturdays, 08:30am-11:30am

(by appointment only)


Prescription requests:

Order your prescription online here.


Do we hold the correct contact details for you? If not, please contact Reception

Online Enquiries

We offer an online facility for queries. 


This service is ideal for simple issues such as Fit Note requests, Test Result enquires, Referral enquires.  It is NOT suitable for complex medical problems or if you are feeling unwell.  In those circumstances, you should telephone for an appointment or phone 111 for medical advice.


Your message will be read within THREE working days.


This service is for Non-urgent administration or medical enquires ONLY. 

If you have a medical emergency then please phone 999.

Out of Hours

Outside of normal working hours, please contact the NHS out of hours service by phone on 111. 


NHS 111 can help if you need urgent medical help or if you’re not sure what to do. They will ask you questions about your symptoms, so you get the most appropriate help. You can also get help from their website:


In the event of a medical emergency call 999

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