BookingInitial consultation

Ninety minutes.
One flat fee.

Fill in what you can. Nothing here is a medical questionnaire and none of it commits you to a treatment — it simply lets us allocate the right appointment and reach you the way you want to be reached.

Urgent

If you are experiencing chest pain, or an erection lasting longer than four hours, seek emergency care immediately. Do not wait for an appointment. This form is not monitored outside clinic hours and must not be used for anything time-critical.

01About you

First name

Last name

Phone

Year of birth

Optional. Helps us allocate the right appointment length.

02Reaching you

You control how we contact you. We follow these preferences exactly — no exceptions, no generic marketing follow-up.

Preferred method

Best time to reach you

Voicemail

If you choose no, we will call once and leave no record.

Mail & correspondence

Anything we send arrives in unbranded packaging as standard.

03What brings you in

Primary concern

How long has this been going on

Anything else we should know

Optional. Medications, existing conditions, or a question you'd like answered at the consultation.

I authorise The E.D. Treatment Center to contact me using the details and preferences above about my enquiry. I understand this form is not a medical consultation and that submitting it does not create a physician–patient relationship.

Submitted over an encrypted connection. Never shared, sold, or used for advertising.

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