Request for Appointment With Mr Paul Nolan Request for Appointment If you are human, leave this field blank. Name * Address * Address Date of Birth * Home Phone Number * Mobile Number * Email Address * GP Name and Practice Address * GP Name and Practice Address Brief History of Symptoms * Brief History of Symptoms What treatment have you had for this condition? * What treatment have you had for this condition? Have you had an MRI scan within the last 12 months? * Have you had an MRI scan within the last 12 months? Insurance Company. Membership Number. Authorisation Code * Insurance Company. Membership Number. Authorisation Code Please choose which day you wish to attend * Monday morning – Ulster Independent Clinic Wednesday morning – The Ulster Independent Clinic Thursday evening – The Ulster Independent Clinic reCAPTCHA Please click the submit button and our office will contact you as soon as possible.
