Waitlist Request - Craig Berry’s Health Centre

Please select the applicable statement: *

I have an existing appointment, but want be waitlisted for a different time.
I have not been able to make a suitable appointment.

Name *

(Please write your name as you're known to me - no nick-names please?)

Your best contact number (to receive waitlist SMS (text) offers. *

Waitlist offers are sent by text in the first instance, so please include a mobile number.

Notification time required (in minutes):

Please tell me (in minutes) how long it would take you from receiving an offer to presenting in clinic for a consultation. If you are realistically 45 minutes away, we will not offer a space only 15 minutes away.

Your reason for seeking a waitlisting:

Pain and debilitation. I want/need to come in as soon as I can.
Work; other commitments; other non-symptom related limitation.
You're booked out in the time I can attend.

This is asked to triage offers in order of need. Thank you for your honesty.

Preferred appointment times:

Please select your preferred appointment times, or specify a specific time and day below.

Specific time availability or request:

Please use this field to detail your need for a specific time (e.g. 5pm only) or for a specific reason (e.g. Bringing "Jane X" for her appointment at 3pm and would like the 4pm if possible, please?)