Ultrasound request

All fields are required.

Have you got a written referral?

Yes

We are not able to offer you a scan until you have a referral from your clinician (e.g. GP, Consultant, Physiotherapist). If you need more information please contact your local GP or referring clinician to discuss your scan requirements.

How will this scan be funded?

Private medical insurance

Self funding

NHS

Other / don't know

Choose your preferred scan centre

London

Alliance Medical Marylebone, London

Select your preferred dateMost centres require a minimum of 7 days advance notice

Your gender

Male

Female

Your name

Your date of birth

Your contact details

Comments

I have read and consent to the website terms and conditions and privacy policy.

Contact permissions

Please provide your permission for us to contact you with information, products or services that you request from us or which we feel may interest you. We fully respect your privacy.

Contact me by telephone

Contact me by email

Contact me by SMS

Thank you! Your scan request has been received. It will be routed to your preferred scan centre who will be in touch shortly to confirm your booking.

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Start to finish first class. Made me feel comfortable and well looked after

T. Young

PET-CT patient