Self- referral to Group Education Menopause Clinic

"*" indicates required fields

What the Group Clinic Is

Please note this is a group educational session.

As a group, up to 6 ladies will chat and share their queries and concerns about menopause with each other. Together, with a female clinician, we will discuss what menopause is, how it affects women, and helpful ways to manage symptoms.

Patient Name*

First Name Last Name

Patient D.O.B*

Patient Address*

Street Address Address Line 2 City State / Province / Region Post Code

(We require this to post your information pack for the clinic)

Patient NHS number*

Patient Mobile Number*

Ethnicity Optional

Registered GP Practice*

I understand other women will be in the group discussion*

Yes

I am willing to sign a confidentiality agreement for group consultation*

Yes

Comments Optional

This field is for validation purposes and should be left unchanged.

Self- referral to Group Education Menopause Clinic

Self- referral to Group Education Menopause Clinic

What the Group Clinic Is

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