Please provide as much information to enable us to give you accurate advice.
Ensure you submit the form at least 4 weeks before intended date of travel.
We will process the questionnaire and pass it to the nurses, you will receive a response via email or text message in the next 3 working days.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Bursted Wood Surgery
219 Erith Road, Barnehurst, Bexleyheath, Kent, DA7 6HZ.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.