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Henry Shaw Clinic

Booking Enquiry Form

You can use the form below to request a possible appointment date with our clinic. You have a first and a second choice of date and time. Upon receipt of your request, we will reply in due course.

NOTE : completing this form does not guarantee you an appointment but simply requests one. Also, whilst the calendar to the right is provided for your convenience, it does not show available dates. Furthermore, we do not normally work Saturdays and Sundays.


Name :	*
Company :		if applicable
Telephone :
Email :	*
Confirm Email :	*

Requested Booking Date
Ideal Date / Time		/ / - dd / mm / yy -
Alternative Date / Time		/ / - dd / mm / yy -

Condition / Treatment		please briefly describe your condition or state the treatment you require.
How would you like to be contacted to confirm your appointment?

Copy - you will automatically receive a copy of this message



	*	compulsory field - please complete

Please remember:

The calendar to the right is for information purposes only
Clicking the calendar does nothing. It is not interactive.
It does NOT show available or unavailable times
Whilst it shows weekends, we do not usually work Saturdays and Sundays

Check your Dates

Check you dates with this
convenient calendar

Max's Calendar

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