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Special Appointment Request

Use this form to request an appointment outside of normal clinic hours. 

Please give the date/s and times requested. Please also be specific as "anytime" or "asap" is not a workable request.
(Please write your name as you're known to me - no nick-names please?)
If your request can be accommodated, offers are sent by text in the first instance, so please include and double check your mobile number.