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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 Balance Paid Clinic.

Have you been referred to from a Surgeon?
Have you had surgery in the last 6 months?
Do you have Private Medical Insurance
Earnings Situation
Earning Bracket - Per Year

Thanks for submitting! We will be in touch shortly!

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

Please note all appointments require a £50 payment, this secures your appointment and goes towards Time, Consumables, Insurances etc.

Should your application not be successful we will be in touch with alternative options, this may be:

Demonstration Treatments

Model Treatments

If your application is successful you will be offered an appointment date and time.  This is usually 6 months from the date your application is approved.

If you are looking for a sooner appointment you will be advised a date and time for the Paid Clinic.

What happens next...