Theatre booking form

This form is for medical professionals only.

Please complete this theatre booking form once you have spoken to the hospital bookings team and they have confirmed your theatre slot.

If you would like to speak to a member of the hospital bookings team, please contact us on:

London: 0203 075 2332

Essex: 01245 801 234


    Select A Hospital
    Patient Details
    Admission Details
    Payment Details
    Price confirmed with bookings team?*
    Letter of guarantee?*
    Extra Requirements
    Is the patient anticoagulated? (Please advise the patient if the Consultant requires the medication to be ceased prior to surgery)*
    C-arm/X-ray/Image-intensifier needed?*
    Micro Air Handpiece requirement?*
    Spot Haemoglobin on admission?*
    Group and Save required on admission – Only required for high risk of bleeding procedures*
    Have you attached details of patients past medical and medication history?*
    Please upload any patient supporting documents:
    For office use
    Completed By

    we will never share your details and will only send you information about our healthcare services