Second Opinion Request Form

Please fill out the form below to request your Second Opinion, providing as much detail as possible. You will then be requested to make payment for the service.


About the patient

Preferred consultant

Preferred consultant

Medical details

Please send documents or images (X-rays, MRIs, CTscans etc) hard copies, or on a memory stick or DVD to:

Linsee Richards, Second Opinion, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UNITED KINGDOM

Please specify


Please specify


Please specify


Please specify


Please specify




Please provide your physicians contact details.


Once you have submitted your form, if you have any questions please contact us on
020 7351 8830