Save time during your appointment by completing your paperwork before hand. Simply click on the form below that relates to the appointment you have booked to download the relevant form, print & complete the questions and bring it with you to your appointment at our surgery.

New Patient Pack
If you are a new patient with us please download this patient pack to find details on our services and procedures, fees, appointments and other important information about Blackbutt Doctors Surgery.

DASS form
If you are coming to talk to your GP about depression or anxiety please fill out the DASS form before attending your appointment. This is a standardised questionnaire to help your GP understand your current condition and how he or she can help.

Referral for iron infusion clinic form
If you attend another practice and your GP has requested an appointment with Dr Rochelle for your iron infusion please make sure your GP has completed and provided you with a copy of this iron infusion referral form.

Iron infusion consent form
Ferinject infusion Patient Consent Form.

IUD form
If you are thinking about an IUD contraceptive please read this information fact sheet and discuss this option with your doctor at your next appointment.

Developmental Checklists

These checklists are for parents with young children. Complete the developmental checklist prior to seeing a doctor and/or nurse to make your appointment more efficient and ensure that any concerns can be found and raised with the doctor in your appointment.

Simply click on your selected form name below and it will open in a new window for you to download or print.

12 months and under

18 months – 4 years

5 years and over