IBD advice line form

Please be aware this is not an emergency service. We prioritise patient enquiries based on the information given below. We will respond to your enquiry as soon as we can. On some occasions urgent enquiries can take up to 72hrs. If you are needing more urgent advice, we recommend that you contact your GP, call 111 or attend A+E. Routine enquiries may take longer.

In as much detail as possible please tell us why you are contacting the advice line, this will help us triage your request appropriately.

About you

Full name*

NHS number*

Date of birth (DD/MM/YYYY)*

Telephone contact number*

Best time of day to contact you*

What best describes the nature of your enquiry?*

Based on the nature of your enquiry, please scroll to the most suitable section of this form

Please complete this section if you are having a flare

Were you diagnosed with IBD in the last 12 months?

Have you been discharged from hospital recently?

If yes, was this for your IBD?

Have you recently had a holiday abroad?

Have you recently had any antibiotics?

Are you currently taking a course of steroids for your IBD?

Have you completed a couirse of steroids within the last 12 months for your IBD?

Please describe the symptoms that you are having and when they started.

Please list all the current medications that you are taking, including others prescribed by your GP or that you buy over the counter

How long have you been using your current IBD medications?

Please complete this section if you are enquiring about your IBD medication

If you need a repeat prescription, please list all the medication names and doses that you need prescribing and when you are due to run out

If you are enquiring about your Homecare medication, including deliveries, please consider contacting the delivery company directly in the first instance. If you still need assistance, please provide more details here

If you have any other questions regarding your IBD medication, please let us know as much detail as possible

I would like to have my test results

Please let us know what test results you require and when the test was done/submitted. Please be aware that blood tests ordered by the IBD team will be reviewed and you should be contacted if we need to act upon any results outside the normal range. Sometimes results can be outside the normal range but may not require any action.

Other issues

If you have a different enquiry such as requesting more blood forms, re-scheduling appointments or letters of support please describe what the issue is using the below box with as much detail as possible

* required fields

Please note this is not a 24-hour service and it is not covered at weekends or Bank Holidays.