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Please fill in this form to request an appointment
with your e-med doctor.

Appointments take place in London NW8, UK.

Normal appointment times are Mon 10:00AM - 5:00PM & Tues - Thurs, 10:00AM - 4:00PM. However we may be able to accommodate other times on specific request.

We will e-mail you back with directions and confirming the time and date of your appointment:

N.B * Indicates complusory information
Firstname *
Surname *
Password (If member)
PIN (if member)
E-mail Address *
Telephone No. *
 
Appointment Date *
Appointment Time *
Alternative Date
Alternative Time
 
Type of Appointment *
Brief Summary of Reason for Appointment
 




N.B * Indicates complusory information

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