Make an enquiry about surgery at Berkshire Grove Hospital.

Name

First Name

Last Name

Contact Number

Address

Please state the procedure(s) of interest:

If you are interested in multiple, please put them here.

Do you have a preferred surgeon?

What is your BMI?

BMI = weight (kg) ÷ [height (m)]²

Do you smoke or vape?

If you have pre-existing medical conditions, please list them here.

If you are currently taking any medication(s), please list them here.

Do you have a contact preference?

Please include any additional information here.

If you need assistance figuring out your BMI please follow this link

If you have any other issues, please give us a call on +44 01628 5622555

Can we help?