Care Enquiry form

Thank you for your interest in CARE. The quickest way for you to book a consultation with one of our Consultants or make a general enquiry is to fill out the form below. More and more patients self-refer and the process is simple and quick.

Which clinic are you interested in?

I would like to

  Our Complimentary Clinic visit gives you the opportunity to meet one of our experienced Fertility Advisors for a 20 minute 1-2-1 informal consultation.<br /><br />There will be the opportunity to ask any general questions regarding the services we provide.<br /><br />We also aim to offer you a brief tour of our facilities whilst you are with us.

  An appointment with a Consultant/Senior Clinician is a chargeable, detailed consultation where your full fertility/medical history will be taken and advice tailored to your situation will be fully discussed.

Please enter your question below *
What treatments would you like information about? *

Please tell us a bit about yourself
Situation *
Title * Gender *
Firstname * Surname *
Date of Birth / / (dd/mm/yyyy)* Contact Tel No *
House No. / Postcode *
Select
Address* Email *
 
 
  Postcode *
City* Country *
Partner details
If relevant, partners name First name Last name
If relevant, partners Date of Birth / / (dd/mm/yyyy)
Fertility History
Have you had previous Fertility treatment *
Current fertility Status (please detail any medical history or previous fertility treatments) *
How did you hear about CARE Fertility? * Details
Please tell us a bit about yourself
Situation *
Title * Gender *
Firstname * Surname *
Date of Birth / / (dd/mm/yyyy)* Contact Tel No *
Address* Email *
 
 
  Postcode
City* Country *
Partner details
If relevant, partners name First name Last name
If relevant, partners Date of Birth / / (dd/mm/yyyy)
Fertility History
Have you had previous Fertility treatment *
Current fertility Status (please detail any medical history or previous fertility treatments) *
How did you hear about CARE Fertility? * Details
Please tell us a bit about yourself
Title * Gender
Firstname * Surname *
Date of Birth / / (dd/mm/yyyy) Contact Tel No *
House No. / Postcode
Select
Address Email *
 
  Postcode *
City Country
How did you hear about CARE Fertility? * Details
Please tell us a bit about yourself
Title * Gender
Firstname * Surname *
Date of Birth / / (dd/mm/yyyy) Contact Tel No *
Address Email *
 
  Postcode
City Country
How did you hear about CARE Fertility? * Details
Preferred Contact*
The best time to contact me is
Preferred Contact*
The best time to contact me is

Data Protection

We may in the future wish to contact you about other products and services provided by the CARE Fertility Group and Beacon CAREFertility. If you wish to receive these, please tick the box

By submitting this request, you hereby give your consent for the above entered data to be held and processed by the CARE Fertility Group Limited in accordance with the requirements of the 1998 Data Protection Act (UK) and to be held and processed by Beacon CARE Fertility Limited (EIRE) in accordance with the requirements of the 1988 Data Protection Act (EIRE) and Data Protection (Amendment) Act 2003 if required, for the purpose(s) for which those companies are registered.


We also welcome referrals from GP's and from Fertility Consultants

NHS Patients

Care has strong and well established NHS links and we pride ourselves on offering treatments to both NHS and privately funded patients. NHS funded patients can book an appointment for a consultation or request their GP or Fertility Consultant provide a referral letter to CARE. If you are in doubt if CARE can provide you with an NHS funded treatment please Contact us or ask your GP.

Previous CARE Patients

If you have previously had treatment at any CARE clinic, please Contact us.