Appointment Request

Please note, clinics are generally held on Monday afternoon at the Ulster Independent Clinic, 245 Stranmillis Road, Belfast, BT9 5JH

Your Name

Your Title

DOB

Postcode

Your Email

Landline Telephone No

Mobile Telephone No

Preferred method of contact

Availability

First choice appointment date

Second choice appointment date

If you would like us to contact or advise a relative or friend regarding your appointment, please give the telephone number and name of the person:

Telephone Number

Name

While we will endeavour to accommodate your first choice appointment date, this may not always be possible as clinics can fill up quickly. Please therefore indicate a second choice (above). We will give you an appointment ASAP. If you would be willing to be advised of cancelations and would be available to accept please indicate below.

Can accept an appointment at short notice if there is a cancelation?