At Ultrasound Scan Clinic, we prioritise transparency with our service users. Whilst ultrasound is a fantastic and reliable diagnostic tool, it’s not suitable for all injuries or concerns.

That’s why we ask you to complete the short booking form below. This helps us assess your query and determine if our services are appropriate for you. If suitable, we’ll contact you within two working days (usually less) to arrange an appointment; if not, we’ll let you know so as to avoid any unnecessary wasted time or expense on your behalf.

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

YYYY

Phone or mobile *

Country

(###)

###

####

Email *

Area to be scanned *

Select one, or all that apply

Groin £180

Abdominal Wall £180

Dedicated Muscle (ie Hamstring, Bicep, Tricep etc) £180

Shoulder £180

Elbow £180

Wrist £180

Hand £180

Hip & Upper Leg £180

Knee £180

Ankle £180

Ankle & Foot £220

Foot £180

Other

Nature of the problem *

Select one, or all that apply

Pain (No Known Injury)

Pain (Caused By Injury)

Lump

Swelling

Other

Tell us more *

Please tell us more about the nature of the problem. Or, if you have selected 'other' in any of the above options, please tell us more here

Duration of symptoms *

Have you had any previous diagnostic imaging and / or treatment for this problem *

Have you consulted a medical professional about this and have they recommended having an ultrasound scan? *

Yes

If you have consulted a GP, please specify their name and practice address. If you have been consulted by a Physiotherapist, please state their name, practice address and contact email.

How did you come to know about our clinic or services? ie Word of Mouth, Google Search, Leaflet, Roadside Advertisement, GP/Physio Referral etc *

Thank you! We will assess if a Musculoskeletal and Soft Tissue Ultrasound Scan is right for you based on the information provided. We’ll aim to contact you within 2 working days