Appointment pre-booking

Tell me about your case and I will contact you as soon as possible to confirm your appointment.

A pre-booking is not a confirmed appointment: it is a request. We contact you to confirm actual availability.

Full name *

Phone *

Preferred contact method

Preferred time

Type of visit

Insurance or private

General reason for consultation *

Anything else you'd like to add? (optional)

Do not include medical reports, full diagnoses or sensitive clinical information. This form does not replace a medical consultation.

I have read and accept the privacy policy and consent to the processing of the data provided (including the reason for consultation, as health data) to manage my request. *I would like to receive health information and tips by email (optional).

The information sent through this form will only be used to manage your contact or pre-booking request. Do not include detailed clinical information. This form does not replace a medical consultation.