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    Personal details

     

    Click on the speciality you would like to book

    When would you like to have the appointment? Please give us your 3 preferred dates and time slots (Example: 28th August 9am to 10am)

    Describe your health concerns (all relevant information that will help to provide an accurate diagnosis)



    Please list the questions you would like to ask the Consultant during the consultation.



    What medications are you on?



    Are you allergic to any medications?



    Please list your medical problems. Example- Hypertension, Diabetes, high cholesterol



    What is the address of your GP Surgery? 

    Name of your GP  

    Please upload any documents/pictures/reports to help during the e-consultation. 



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