- About You
Health Needs Assessment Form during COVID-19
At this time, we are continuing to support our clients by arranging e-consultations with top UK-based medical professionals.
Please visit our Medical e-Consultations page for more information
Once we receive your completed form, we will contact you within 24 hours.
Tell us a bit about yourself
* We comply with the European Union’s General Data Protection Regulation (GDPR). Please see
Tell us about your health problem
Please provide details of your diagnosis.
Please provide your doctor/surgeon's address.
Please provide details of any treatments you have had to date.
Tell us about your medical history
Have you ever had any of the following?