Self Referral

If you are over 18 and looking for help, we can arrange for an outpatient assessment with a view to outpatient treatment for those who are self funding or those with AXA insurance with appropriate cover. If you would like to speak to someone then please call 020 8906 6900 ext 227 or complete this form to make an enquiry and we will be in touch to help guide you.

Enquiry Form

Your details



Where did you hear about Ellern Mede?*

How would you like us to contact you?*

What time would you prefer to be contacted?*

Select a condition*

Type of treatment programme*

Please indicate your your preferred payment option* I will be funding treatmentI have insuranceOther

 

 
I understand that by ticking this box and submitting this form, I consent to Ellern Mede contacting me by email or phone in order to process my enquiry. Ellern Mede will not pass your details onto other companies or third parties.

 

Please call  +44 (0)20 3209 7900 ext 227 to find out more. Or alternatively please feel free to email us at [email protected]  You can read about the NHS Referral process here.

Confidentiality
Your enquiry will be handled in the strictest of confidence and responded to the same or next working day. You are welcome to read our patient confidentiality policy.

Funding or payment arrangements will be discussed prior to your first appointment. We will send you our Terms and Conditions. Payment is in advance of each appointment.