UPLOAD YOUR REFERRAL(S)

  • of the person undergoing the scan
  • Date of birth
    Date Format: DD slash MM slash YYYY
  • Who we should call to arrange the booking
  • Contact email
  • Upload your file(s) here. jpg, jpeg, png, pdf ONLY. Compatible mobile devices will direct you to capture or upload a photo or file.
    Drop files here or
    Accepted file types: jpg, jpeg, png, pdf.
  • Any important information we should know before contacting you?