Second medical opinion form

Please supply a brief explanation of the general nature of your condition and your requirements.

Please indicate if you have a supporting medical report.

Please upload a supporting medical report.

Please tick 'Yes' to confirm that you have read and reviewed our Terms and Conditions.

The London Clinic is fully committed to compliance with Data Protection and Department of Health medical confidentiality guidelines. The personal information that you submit using this form will be held securely by us and your personal information will not be shared with anyone outside of The London Clinic or used for any other purpose than to respond to your enquiry and / or request. Please confirm how you would like us to contact you:

Protecting your information
Please see our privacy notice for details on how we use your personal data and how you can withdraw your consent to our communications.