CBT Clinic London: New Patient Registration Form

  • Patient Details:

  • dd/mm/yyyy
  • Payment Details:

  • If you are using Private Healthcare, please contact your provider to obtain this number.
  • GP's Details:

    We will only use this information in case of an emergency and we would always try to contact you first.
  • CBT Clinic London Policy on Missed or Cancelled Appointments

    Please read carefully the policy on our website and tick the box below to confirm that you agree to comply with our terms and conditions in relation to Missed or Cancelled Appointments - Thank you.
  • How did you come to hear about us?

Share This