Book an appointment

Please provide as much information as possible on the form. The form cannot be submitted without the mandatory information marked with an asterisk (*).
Name*
Please enter your full name
Address Line 1
Please enter the first line of your address or the name of the building you live in.
Address Line 2
Please enter the second line of your address
Town or City
Please enter the name of your closest town or city
Postcode
Please enter your postcode
Appointment Date*
Please choose the date for your appointment.
MM slash DD slash YYYY
Appointment Time*
Normal consultation times are: 7.30am - 6.00pm

Hours :

Minutes
Mobile telephone number*
Landline
Email address*
Enter Email Confirm Email
Alternative appointment time
Please enter a second choice for your appointment Date and Time (optional)
Data protection and privacy*
By submitting this form you agree to Dr Susan Horsewood-Lee saving your personal information for the purposes of dealing with your request or enquiry. You can read our Data protection policy here.
- Yes I agree to your Data protection policy.
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Phone
This field is for validation purposes and should be left unchanged.