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Step 1: Who is this appointment for?

Are you booking for yourself or on behalf of someone else?(Required)

Myself

Someone else

Contact Details for the Person Making the Booking

Name(Required)

First Last

Phone(Required)

Step 2: Personal Details

Tell us a little about the person that needs the appointment. All details will remain private and secure.

Name(Required)

First (include any middlenames) Surname

Phone(Required)

Email(Required)

Date of birth(Required)

Day

Month

Year

Address(Required)

House Number and Street Name City Postcode

Step 3: Select a service

Select the service you need and your preferred date and time. We'll do our best to accommodate your request.

How can we help?(Required)

GP Visit

Nurse Visit

Blood Test

Physiotherapy Appointment

Podiatry Appointment

Other...

What type of appointment do you need?

How can we help?

If you need a service that is not listed above, specify your needs and we will do our best to provide a solution.

Preferred date(Required)

MM slash DD slash YYYY

Preferred time(Required)

Step 4: Additional Information

Share any relevant health details, symptoms, or concerns. This helps us provide the best care possible

Symptoms or Concerns(Required)

Briefly describe your symptoms, health concerns, or the reason for your appointment. This helps us prepare in advance.

Upload Medical Documents (Optional)

If you have any relevant medical documents, prescriptions, or test results, you can upload them here.

Max. file size: 8 MB.

Step 5: Payment & Confirmation

Let us know how you'd like to handle payment. If you have insurance, we may be able to process it for you. Almost done!

Do you have private health insurance?(Required)

If you have private health insurance, we may be able to process your claim directly. Please provide your insurer's details.

Yes

Insurance Provider(Required)

Please provide your insurer's details.

Preferred Payment Method

Choose how you’d like to pay for your appointment. If unsure, feel free to ask us when we will contact you.

GDPR Consent(Required)

I agree to Square Care securely storing and processing my personal data for this booking.

We take your privacy seriously. Your details are securely stored and only used for providing medical care. Read our [Privacy Policy] for more information.

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Step 1: Who is this appointment for?

Contact Details for the Person Making the Booking

Step 2: Personal Details

Step 3: Select a service

Step 4: Additional Information

Step 5: Payment & Confirmation

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