We are here for you every step of the way

Name *

First Name

Last Name

How will you pay for your treatment or consultation? *

Private Medical Insurance

Self-pay – I will be paying the fees

By completing this form, you agree to the following: *

I understand that The Wye Clinic will store the information provided here on Google’s secure web servers until the generated email has been read and and acted upon. It will then be permanently deleted from the server. I confirm that I am happy to be contacted by The Wye Clinic team to discuss making an appointment. If I am submitting this query on behalf of someone else, I confirm that I have their consent to submit this information and that they are happy to be contacted for the same. I understand that this information will not be used for any other purpose including marketing.

Name *

First Name

Last Name

GP name *

First Name

Last Name

Does your question relate to any of our services if so, please indicate this below?*

Ophthalmology/Eye Surgery

Orthopaedics

Menopause

None of the above

By completing this form, you agree to the following: *

I understand that The Wye Clinic will store the information provided here on Google’s secure web servers until the generated email has been read and and acted upon. It will then be permanently deleted from the server. I confirm that I am happy to be contacted by The Wye Clinic team to discuss making an appointment. If I am submitting this query on behalf of someone else, I confirm that I have their consent to submit this information and that they are happy to be contacted for the same. I understand that this information will not be used for any other purpose including marketing.