Appointment Booking

	To make a booking for an appointment please complete the following form. Acceptance of the appointment will be confirmed by email or phone within 1 working day. If you provide preferred time & dates we will endeavour to confirm an appointment at one of those times where possible. Items with a (*) are required.
Name: (*)	Please enter your full name.	Please enter your full legal name.
Phone: (*)	Area code & phone number we can use to confirm your booking. Please numbers only - no spaces.	Area code and phone number required for confirmation of appointment. No spaces.
Your email address: (*)	Please provide a valid email address.	Email address we will use to confirm appointment.
Consultation type:	Medical or health problemTravel consultation - generalTravel consultation - malaria medication only Immigration medicalDiving medicalContraception or sexual healthGeneral medical check upOther Please select appropriate type of consultation
Number of people attending:	Please enter a number only.
Comments:	Invalid Input	If possible provide reason for appointment and any information you think is useful.
Preferred time(s):	Please provided your preferred time(s)for an appointment.	Please provided your preferred time(s)for an appointment.
Preferre Date	Please provide a date for appointment.	Click to select input calendar.
Verification:	Refresh Text Incorrect verification please try again.	Enter code shown to verify a person is entering data.
Click button to send booking: