Arrange an Appointment

Please complete your details below and click the send button.
We shall reply to your query at the earliest opportunity.

Make an appointment
Name
Name
First Name and middle initial(s)
Last Name
Include Country Code if outside UK
Include Country Code if outside UK
0 of 500 max characters

Maximum file size: 10MB

New Patient?

New patient?
Please check the box to display the 'New Patient' form, which must be completed before you can request an appointment

(* = Essential information )

Part A - General details

Name
Name
First Name and middle initial(s)
Last name
Please add full address including post code.

Contact details

(incl Country Code if outside UK)

For insured patients

Please check for any potential shortfall - insurance covers varies

General Practitioner details (if known)

Referral basis

Please check any of the boxes which apply

Referral basis

Part B - Medical details

Please check the box(es) if you have a history of any of the following conditions
Allergies

Part C - Medications

Are you on any medication?
List any tablets, the dose and frequency per day that you are on
List any eyedrops you take, and the number of times installed per day in the right and left eye

Part D - Details of other doctors you see (ENT, endocrinology, dermatology, etc)

List the details of any other doctors you see by supplying their name, speciality and contact details / address

The information you provide will be used solely to respond to your medical enquiry and to provide appropriate follow-up. Your details will remain confidential and will not be shared with any third parties.