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Patient Appointment Request

If you have a confirmed cancer diagnosis and the relevant paperwork as listed on our appointments information page please complete the secure online form to request an appointment with one of our consultants.

Patients can also be treated by our consultants in your home if you are registered with the Bupa Home Healthcare scheme. For more details about the scheme click here


  • If the patient has private medical insurance, Please choose from the drop down, if not please select Self Funding
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  • This field is for validation purposes and should be left unchanged.

Independent Practice Services is fully committed to compliance with Data Protection and Department of Health medical confidentiality guidelines. The personal information that you submit using this form will be held securely by us and your personal information will not be shared with anyone outside of Independent Practice Services, or used for any other purpose than to respond to your enquiry and/or request.