Book an Online Consultation | Surrey Allergy Clinic

During the COVID-19 Pandemic lockdown we have introduced a system of online consultations to try and minimise face-to-face consultations and increase social distancing. Allergy assessments and testing are well suited to this type of remote online web consultation. To obtain maximal benefit from our online consultation process, we need to fully assess that your particular allergy-related problem can be diagnosed, treated and resolved with an online remote consultation. To aid us with this assessment, please fully complete the attached form and we will then contact you by phone or email to offer an online consultation at a date and time convenient to you. This web consultation will provide us with information on the nature of your allergy and then we can decide on the most appropriate cost effective allergy tests to be performed and management plan.

Name*

Forename Surname

Email Address*

Enter Email Confirm Email

Mobile Phone*

Landline

Date of Birth*

Gender*

Male
Female

Skype Name / Zoom ID

Home Address

Street Address City Post Code Country

Have you had any pre-existing allergy conditions?

Do you have any pets at home?

Cat
Dog
Other

Other text field

Would you like to request a date for your online consultation (Tuesdays only)?

Date

Reason for consultation (tell us details of your suspected allergy)*

Symptoms, duration, season or all year around, previous tests and treatment taken thus far.

Expectation and outcome of allergy consultation*

Phone

This field is for validation purposes and should be left unchanged.