Book Your radiology Appointment

Step 1 of 7: Start

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What can we help you with today?

Please choose one option below.

Request a scanBook or enquire about treatmentProfessional or referral enquiryGeneral enquiry

Do you have a referral for this scan?

Yes, I have a referralNo, this is a self-referralI’m not sure

Which best describes you?

GP / Referring clinicianOther Healthcare ProfessionalOrganisation / Company RepresentativeOther (please specify)

Please specify

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Who are you contacting us about?

This helps us understand whether we should record you as the patient or as the person enquiring on behalf of the patient.

Are you enquiring for yourself or on behalf of someone else?

I am the patientI am enquiring on behalf of someone else

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Your details

Please provide the contact details of the person submitting this enquiry.

Your contact details

Please enter your contact details here.

Title *

Full name *

Date of birth *

Postcode *

Phone number *

Email address *

Patient details

Please provide the details of the person the enquiry is about. This is useful where the patient is under 18, elderly, unwell, or unable to complete the form themselves.

Patient title *

Patient full name *

Patient date of birth *

Your relationship to the patient *

Patient phone number

Patient email address

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About your enquiry

Please tell us how best to contact you and which specialty your enquiry relates to.

About your enquiry

How did you hear about us? *

Preferred contact method *

Best time to contact you

Specialty *

Will your appointment be self-pay or insured? *

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Details about your enquiry

Please provide a short summary and any supporting information.

Details about your enquiry

Please provide a brief summary of your enquiry *

Any additional information that will help us assist you?

Upload relevant documents, if applicable

PDF, JPG or PNG only. Max 10MB per file.

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