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APPLICATION FORM

Please fill out the following form to help us understand your physical condition and to determine if you are a candidate for the FREE Clinic.

Have you had surgery in the last 6 months?
Have you been referred by your surgeon or oncologist

Thanks for submitting! We will be in touch shortly!

As spaces are very limited for the FREE clinic, we will assess your application form and let you know if there is a slot available.

Please note all appointments require a £50 deposit, for the FREE clinic this can either be:

  • Paid Forward to another person

  • Donated to the clinic for stock, consumables, insurance and time

  • Refunded after your appointment

What happens next...