We'd really like to say thank you please provide their details and email address/phone number if you have it
If we need to contact your GP, we will ask you before we do this.
If you don't want us to at all please let us know.*
I am happy to consent for a consultation at Perfect Balance Clinic
Thank you for completing the initial registration form. This will help during your appointment as we will be able to concentrate on helping you.
We take our data protection seriously and no information will be shared or otherwise used except for the purposes intended.
By registering with the clinic and sending this application you are agreeing to abide by our 24 hour cancellation policy, details of which can be sent to you should you wish.