The Burghley Park Clinic
Queen Elizabeth Drive
Swindon, Wiltshire
SN25 1WL
Email:enquiries@burghleyparkclinic.com

Phone: 01793 709 580
Fax: 01793 709 581

You may be interested to note that many of the enquiries that we receive at The Clinic are from people who have not sought assistance from a medical clinic before.

Please do not put off calling - we have a rule "no question, (however obvious the answer) is ever considered silly" - we will have been asked most things before and it is important that you feel comfortable about all aspects of your treatment before we start treating you.

If you would prefer us to contact you, please complete the form below to have your details e-mailed to us and a member of our staff will contact you to discuss your requirements.

Please remember to give us at least one method of contacting you or we will not be able to contact you back.

Title *	Miss Ms Mrs Mr Rev Sir Lady Dame Lord Sgt Capt Cpl General Dr Other
First Name *
Family Name *
Mobile
Telephone
email *
(This must be an address to which you don't mind us sending you confidential email)
If calling your number, when would it be best to call you e.g. during the day / evenings / weekends?
Please indicate if it would be OK for us to leave a message on either number
	YesNo
Are you aged over 18 yrs ?
	Yes (over 18)No (under 18)
(Please note - most therapies need signed parental consent if you are under 18).
Date of Birth
or Age
Would you like us to send you a brochure ? ( Please note - we will require a postal address if you wish us to post you a brochure in a plain envelope addressed to you marked "Private and Confidential"). The full brochure is now available on line
	Yes pleaseNo thank you
Address
To help us tailor the information to your requirements, what aspect of our services are you interested in knowing more about ?
If you could indicate below from where you first learned about the services available at The Burghley Park Clinic e.g. recommended by a friend / Web Search via Google etc. This would help us identify any areas of communication we need to strengthen in future.

Our friendly and approachable staff will help you with any queries you have about the clinic and its extensive range of services.

Click here to
for more information.