Minor surgery request
We can offer removal of small lumps and bumps under local anaesthetic. Please fill in this form if you are interested. Your request will be checked for suitability and you will receive a response by text message or telephone.
Name
*
First Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Mobile phone number
Email
example@example.com
Where on your body is the lump / bump?
*
How long have you had this lump / bump?
*
What symptoms it is causing? eg catching on clothing / pain / itching / discharging etc
*
Are you on any blood thinning medication? If so, what?
*
I will upload a photo
*
yes
no
Please upload a photo / photos, unless an intimate area is involved (eg genitals, breasts). Place a ruler or coin next to the lump for scale.
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of
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Should be Empty: