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Referred under NHS?
For patients who are referred for a scan under NHS, but are willing to pay for a private scan to have a quicker appointment. We usually provide an appointment within 5 working days.
Preferred Appointment Date
Preferred Appointment Time
No Preference
Morning (Between 9am to 12pm)
Afternoon (Between 12pm to 4pm)
Evening (After 4pm)
Name
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Email
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Secondary Phone Number (optional)
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Date of Birth
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Address - First Line
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Postcode
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Clinical Details
Do you have a copy of your NHS referral letter?
*
Please select one option
Yes, I have a copy of the letter
No, I do not have it with me
Upload Referral Letter(s)
The letter needs to be signed by the referring clinician and must have the patient full name, date of birth, clinical indication, type of scan requested and the signature of the referring clinician.
What scan or test were you referred under NHS?
*
Symptoms (Please provide symptoms detail and since when are you having these)
*
Any related surgeries or treatments in the past?
Any known medical conditions?
Any special requests?
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