e-med recommends:
for Travel Insurance
Please fill in this form to request an appointment
with your e-med doctor.
Appointments take place in London NW8, UK.
Normal appointment times are Mon / Fri 7:00AM - 6:00PM. However we may be able to accommodate other times on specific request.
We will e-mail you back with directions and confirming the time and date of your appointment:
N.B
*
Indicates complusory information
Name
*
Password
(If member)
PIN
(if member)
E-mail Address
*
Telephone No.
*
Appointment Date
*
Appointment Time
*
Alternative Date
Alternative Time
Type of Appointment
*
- Please Select -
Routine Consultation
Urgent Consultation
Health Check
Diving Medical
Travel Clinic
Minor Surgery
Other
Brief Summary of Reason for Appointment
N.B
*
Indicates complusory information
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Last Updated: 10-May-2002