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Request an appointment with Mr Aman Khanna

Send your details and Farah Baig, Mr Khanna's practice manager, will contact you to arrange a time.

This form is not monitored for urgent problems. If you need urgent medical help, call 111, or 999 in an emergency.

Full name

*

Email address

*

Telephone number

*

Have you seen Mr Khanna before?

*

A

No, this is a new consultation

B

Yes, this is a follow-up

How will the appointment be paid for?

*

A

I am paying myself

B

Private medical insurance

Insurer, if you are insured

Where would you like to be seen?

*

Days or times that suit you

What would you like to discuss?

A sentence or two is enough. You do not need to give medical detail here.

Your consent

*

I agree that my details can be used to arrange my appointment