We appreciate your comments and suggestions and welcome
enquiries.
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 contacting us - 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.
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Title* |
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Forename*
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Surname*
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House Name or Number*
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Street*
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Address 2 |
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Town* |
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County |
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Postcode*
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Country:* |
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Daytime Telephone Number*
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Mobile Telephone Number |
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Email Address* |
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Please
tick here
to confirm that you are over 16 years of age ( for all laser acne
treatment enquiries)
Or
over 18 years of age (for all other treatment enquiries) |
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Date of Birth DD/MM/YYYY please
Gender please
Female
Male
Other |
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Would you like to know more about any of the following treatments or
areas that concern or bother you? |
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What would you like us to do?
I
would like you to contact me to arrange a
consultation please
I would like you to send me a Brochure
( Please note these are available for download from our resources page)
I would like you to send me a
Client Guide to
Services
( Please note these are available for download from our resources page)
I would like a
call from a staff member of the clinic to discuss things further.
Preferred Time/Day for call back
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Please may we ask where did you hear about us? |
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Please may we ask did
you use a web search engine and if so which one? |
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If you do not wish to receive other marketing related material from
us, either by e-mail, SMS or by post, please tick this box
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