make an appointment

If you would like to make an appointment, and have read our information in Before you arrive, you will need to telephone or send an enquiry form to our Patient Liaison team and one of us will call you back as soon as possible. You can either submit it to us here online or download, print and then fax it once completed. Click here for contact details.

Please select from the following options (you may choose more than one) and fill in details as appropriate.

If you wish to make an appointment on behalf of someone else, please fill in the details as if for the patient himself but give us your own name and contact details where indicated at the bottom of the form.

My enquiry

I would like to make an appointment because: I have been diagnosed with prostate cancer I have been diagnosed with benign prostate enlargement (BPH) I have symptoms which need investigating I would like a second opinion I would like a health check
My Details
Title	*
First Name	*
Surname	*
Date of birth	*
Telephone	*
E-mail address	*
Confirm E-mail address	*
Address
	I have/will have a referral from my GP and/or specialist *
	I have health insurance * If yes, please specify
	When did this problem start? (leave blank if requesting health check)
My contact details - I am not the patient
Title
First Name
Surname
Telephone
E-mail address
Confirm E-mail address
Address