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Medical Specialists Information
Our Italian Retreat
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Home
Meet the Team
Services
Medical Specialists Information
Our Italian Retreat
Testimonials
Contact Us
Book a session
Name
*
First Name
Last Name
Email Address
*
Mobile
*
What is the main symptom/condition that you would like help with?
*
Please note any medication for depression / anxiety / psychosis
*
Please indicate appointment preference:
*
Face-to-face Central/NW London
Face-to-face St. Albans
Skype
Day
Evenign
Are you self funding?
*
Yes
No
Insured Patients
*
Name of Insurers
*
Policy Number:
*
Authorisation Number:
*
Please Note:
1) THE FULL FEE IS PAYABLE IN CASES WHERE THE CANCELLATION IS LESS THAN 24 HOURS 2) ANY EXCESS NOT COVERED BY THE INSURANCE POLICY IS THE PATIENT’S RESPONSIBILITY
Thank you!
