Appointment Form

If it is difficult for your current medical advisor to arrange a referral to us, please complete the form below and we will do our best to arrange a consultation. Please remember that before we can do this we will need from your current medical advisors details of your medical history/report; the results of any investigations such as scans; the written histopathology report; and details of any treatments you may have received to date. This needs to be sent to us BEFORE an appointment can be made and unfortunately we are unable to make any exceptions.

We regret we cannot provide any advice or give an opinion by phone or by email.

PLEASE READ OUR FAQ’s (click here) BEFORE COMPLETING ONE OF THESE FORMS

Option 1. I am the patient requesting the appointment

Option 2. I am NOT the patient requesting the appointment