Details of the Technical issue
Which type of device are you using?
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*
Laptop/computer
Smartphone
What date did this occur on?
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*
What time did this occur?
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*
Was there an error code or message displayed?
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*
No
Yes, error 500
Yes, other
Please describe the error code you experienced?
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What where you attempting to do when the error occurred?
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*
Have you recently changed your email address or phone number?
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No
Yes
What was the PREVIOUS email address, or phone number?
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What is the new email address, or phone number?
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Your contact details
Your name
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*
Your NHS number (optional)
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Your email address
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*
Your phone number
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*
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