Make your enquiry

If you are ready to make an enquiry to HCA Healthcare UK, on behalf of a patient, please fill in the form below. Please include as much information as possible about your medical history and the reason for your enquiry.

We will aim to respond to your enquiry within one business day. Please note that this enquiry form is for non-UK residents only.

Type of enquiry (required)

If you selected 'other' please provide further information

About you

Your title (required)

First name (required)

Last name (required)

Email address (required)

Phone number

Your relationship to patient

Do you have permission to speak on behalf of the patient? (required)

Please provide the details of the patient you are enquiring on behalf of.

Patient's title (required)

Patient's first name (required)

Patient's last name (required)

Patient's email address (required)

Patient's phone number

Patient's gender (required)

Patient's date of birth (DD/MM/YYYY) (required)

Patient's nationality (required)

Patient's country of residence (required)

Does the patient have a confirmed diagnosis?

Please provide further detail about the diagnosis here.

Payment method (required)

Who should we contact about this enquiry? (required)

If you have selected 'other' please provide a contact email address and/or phone number

Please provide a brief description of the patient's medical history, including any treatment and current symptoms (where relevant).

We won't share your contact information with anyone outside of the HCA Group.

Read our privacy policy.

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