Book Appointment

Scan Booking Request (Self Pay)
An independent GMC registered GP will assess the form and will call within a few business hours to discuss recommend an appropriate scan

Preferred Appointment Date

Preferred Appointment Time

Name *

Email *

Phone Number *

Secondary Phone Number (optional)

Gender *

Date of Birth *//

Address - First Line *

Postcode *

Clinical Details

Type of Scan Requested

Body Parts to be Examined *

Symptoms (Provide details for each body part to be examined. For how long you had the symptoms?) *

Have you had other tests or scans for these symptoms? When?

Have you shown it to your GP or Consultant? What are their comments?

Any related surgeries or treatments in the past?

Any known medical conditions?

Any special requests?

Important - Please mark if the patient has any of the below conditions:

Terms and Conditions *

I agree to the terms and conditions. I understand this request will be assessed by an independent GMC registered clinician in the UK. The clinician may approve the request, deny the request or may suggest another diagnostic or screening procedure.

If you are self referring, please fill the below Scan Booking Request form.

If you have a referral letter from your GP/Consultant, please Upload Here.

Clinical Details

Multiple Locations

Advanced & Regulated

Qualified Staff

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