Thank you for booking your general medical consultation.

Patients use this consultation form to make a specific request for a medication or therapy privately. Often these are unlicensed medicines, being used off label for cancer or additional therapies for autoimmune disease not allowed on the NHS

This form will be emailed to you, if you do not have the information required to hand, but it must be filled in completely before the consultation is due to happen.

You will need to have identity information, and medical history at the end – we will need some more information from you.

The more information you give us, the better the consultation is going to be for you. Please note, our prescribers are not able to prescribe controlled drugs.