Please complete the form below to help us prioritise and allocate your request to the most appropriate clinician - please ensure you submit your request on a day that you are available as these are on the day requests.

Please note this form is for medical consultations ONLY - visit our Admin Queries page for any non-clinical requests.

Requests made on behalf of someone over the age of 18+ must ONLY be submitted if we have received written consent that you are allowed to do so.

If this has not yet been done, please see our admin query page to complete this first.