To request an appointment please complete the form below and then click 'Submit'. Please note that it is not obligatory
to fully complete the form at this stage, however I will need to ask all the questions contained in the form prior
to commencing treatment, and therefore completing it now will reduce the time taken for your first appointment, and may
save you an unnecessary journey in the unusual event I am unable to commence treatment, either because of a need to contact
your GP or if treatment is contra-indicated. Please also note that all information supplied will be kept in strict confidence,
and your GP will not be contacted without your prior consent. Thank you for taking the time to complete the questionaire
and you will be contacted shortly. In the meantime, thank you for your interest.