A health professional acting on your behalf has recently requested a Skin Camouflage Service appointment for you. We’re nearly ready to book your appointment but need a bit more information about you before we can do that.
Please complete the secure and confidential form below. Please note that we cannot book your appointment until you have filled in this form.
If you are in England, you will need your NHS number to hand when completing the form. You can find this on any written correspondence from your GP surgery or can get it by contacting them directly. If you live in Scotland, you will not be asked for this on the form.
What happens next? Once complete, a member of the skin camouflage team will assess your needs and will contact you by phone or email when an appointment becomes available at our closest clinic to you.
Complete Your Referral
If you have any difficulties completing this form or have any other questions, please contact the Skin Camouflage Service on 0300 012 0276, or email [email protected].