Appointment Deposit NEW PATIENT APPOINTMENT To confirm your appointment, a deposit of 50€ is required DUE TO THE HIGH VOLUME OF NEW PATIENT APPOINTMENTS ON OUR WAITING LIST, WE REQUIRE A DEPOSIT OF 50e TO CONFIRM YOUR APPOINTMENT which can be paid by credit card using the link below. You will receive an automated receipt of payment to your email address. THANK YOU Name* First Last Email* Phone*Appointment Date* Date Format: MM slash DD slash YYYY Contact PermissionDeposit price Price: 50,00 € I Agree to be contacted by phone & email in relation to this enquiry* YES Patient Database Protection Permission Agreement To facilitate your patient care, we need your permission to contact you and any other medical service providers agreed with you, during the course of your treatment, by email, SMS, phone and other electronic means. We'll always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. All personal data which is emailed, is encrypted, password protected & GDPR compliant This iframe contains the logic required to handle Ajax powered Gravity Forms.
