Eligibility Questionnaire

Eligibility Questionnaire

Please complete this short questionnaire to help us understand your needs. A member of our clinical team will review your information and be in touch within one working day.

Confidential & Secure

Your information is encrypted and held in strict confidence. We will never share your data without your explicit consent.

Your Information

Please complete all required fields marked with an asterisk *

Personal Details
Please enter your full name.
Please enter your date of birth.
Please enter a valid email address.
Please confirm your email address.
Service Interest
Please select a service.
Treatment History
Please select an option.
Please select an option.
Medical History
Please select an option.
Pregnancy Status
Please select an option.
Additional Information
Consent
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Thank You — We've Received Your Questionnaire

A member of our clinical team will review your information and be in touch within one working day to discuss your options and next steps.

What Happens Next?

1

Questionnaire Review

Our clinical team carefully reviews your responses, typically within one working day.

2

Screening Call

A member of our team will contact you at your preferred time to discuss your history and answer any questions you may have about the service.

3

Eligibility Confirmation

Based on your responses and screening call, we will confirm whether you are suitable for a full consultant assessment.

4

Consultation Booking

If eligible, we will guide you through booking a full initial consultation at your preferred clinic location — Hampstead or Knightsbridge.