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  • New patient enquiry

    Please Fill the form below and let us know what appointment type you need. We will get back soon to you for more updates.
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  • Have you previously attended a clinic with Mr Laniado?*

  • Appointment Type

  • Please tell us what your consultation is about?*

  • Please provide information below about your condition by filling in the box below and by uploading files including letters from other doctors, scans (ultrasound, MRI, CT), biopsy, blood and urine results if you have them.

    Thank you

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  • Do you take any medication by mouth, inhalers, skin patches or otherwise?
  • Do you have allergies to have medications or other substances?
  • Have you had any biopsies or operations before, e.g. on the prostate, the abdomen such as hernia repairs, appendicectomy, gall bladder, or exploratory operations?

  • Now for some questions about your general health. Please answer as best as you can. An approximate or closest answer is fine, so please do not worry if you are not sure.

  • Do you have or have you had problems with blood supply to the heart leading to a heart attack?*
  • Please select one of the options below or type in the box*

  • Do you have or have you had problems with the blood supply to the heart or chest pain on exertion or angina?*
  • Do you have or have you had problems with the blood supply to the heart or angina? Or type in the field*

  • Do you have or have you had problems with heart failure? The symptoms are short of breath on lying flat, swollen ankles, feeling tired all the time*
  • Please select an option if you have you had problems with heart failure (shortness of breath on lying flat, swollen ankles, tired all the time) in the empty box*

  • Do you have or have you had problems with an irregular pulse or palpitations?*
  • Do you have or have you had problems with an irregular pulse or palpitations?*
  • Do you have or have you had high blood pressure?*
  • Do you have or have you had high blood pressure?*
  • Do you have or have you had problems with the veins or venous circulation to your legs or arms?*
  • Do you have or have you had problems with the arterial circulation to your legs or arms?*
  • Do you have or have you had problems with the lungs and breathing due to asthma, bronchitis or emphysema?*
  • Do you have or have you had problems with the liver or oesophagus?*
  • Do you have or have you had problems with stomach ulcers?*
  • Do you have or have you had problems with malabsorption or inflammatory bowel disease such as Crohn's disease or ulcerative colitis?*
  • Do you have or have you had problems with the pancreas?*
  • Do you have or have you had kidney problems?*
  • Do you have or have you had diabetes?*
  • Have you ever had a stroke or TIA?*
  • Do you have or have you ever had memory problems?*
  • Do you have paralysed arms or legs?*
  • Do you have multiple sclerosis, Parkinson's disease or other long-term condition affecting your nerves or muscles?*
  • Do you have or have you ever had a psychiatric problem*
  • Do you have a rheumatological condition such as rheumatoid arthritis, polymyositis, Lupus, connective tissue disorder)?*
  • Do you have AIDS?*
  • Do you have or have you had cancer (e.g. bowel, lung, pancreatic, melanoma)?*
  • Do you have or have you had leukaemia or myeloma*
  • Do you have or have you had lymphoma?*
  • Do you drink alcohol?*

  • Do you take recreational drugs?*

  • Do you know your height and weight?*

  • Thank you very much for completing the form. The information is held confidentially.

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