Home
Technology
Scans
Sports Injury
Our Team
Your Visit
GP/Specialist
Media Centre
Contact Us
Enquiry Form
Which scan would be best for you?
If you are unsure which scan would be most appropriate for you, please complete the below form and you will be contacted shortly with feedback.
1) Which scan(s) would you like to have? (Tick all that apply)
Available EBCT Scans:
Heart Scan
Bone Mineral Density (BMD)
Lung Scan
Electron Beam Angiogram*
Abdominal and Pelvic Scan*
Virtual Colonoscopy
Health Assessment 1
(heart, lung and virtual colonoscopy)
Health Assessment 2
(heart, lung, abdomen, pelvis and virtual colonoscopy)
* = Doctor referral necessary
Available Ultrasound Scans:
Prostate Scan
Testicular Scan
Abdominal Aorta Scan
Neck Arteries (Carotid Doppler)
2) Other enquiries:
3) Please briefly summarise your reasons for having this particular scan(s)?
(symptoms, family history, peace of mind etc)
4) Please mention any investigations or consultations over the last five years?
(if any)
5) Your Contact Details
*Title:
*Surname:
*First Names:
*D.O.B:
e.g. DD/MM/YYYY
Address:
Postcode:
*Telephone:
(Daytime)
Mobile:
E-mail:
* = mandatory