Booking Form

IMPORTANT: This is a request form only.
We do need to check our diary – you will need
to talk to us on the phone to secure your booking
after completing this form.

We screen at more than 20 clinics nationwide –
Call us or fill in the form below to book your
appointment at a clinic near you.

Address:
Medical Thermal Imaging Ltd
71 Lord Sefton Way
Altcar
L37 5AB

Phone:
0333 8003003
This number is normally included in mobile contract charges.
Local landline charges apply.

Email:
[email protected]

An asterisk (*) indicates a required field.
 
Your Name *
Email *
Phone number *
Your postcode *
Type of screening *







Are you an existing patient *


How did you find us? *
If 'other' above, please provide details
If 'referral' above, please provide details
Many of our patients find it easier to set up a standing-order at £15 p/m (£180 p/a) for their annual thermography screening.

To do so, please download the Standing-order mandate here, then scan and submit it below once you've completed it.
Alternatively you can send it to us in the post -
Medical Thermal Imaging Ltd, 71 Lord Sefton Way, Altcar, L37 5AB
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