At Ultrasound Scan Clinic, we prioritise transparency with all our service users. Whilst ultrasound is a highly effective and reliable imaging tool, it may not be suitable for every breast concern.

That’s why we ask you to complete the short booking form below. This allows us to review your query and determine if a breast ultrasound is appropriate for your situation. If suitable, we’ll contact you within two working days (usually sooner) to arrange an appointment. If not, we’ll let you know promptly to avoid any unnecessary time or expense on your behalf.

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

YYYY

Phone or mobile *

Country

(###)

###

####

Email *

Area to be scanned *

Select one, or all that apply

Thyroid / Neck £180

Groin £180

Abdominal Wall £180

Dedicated Muscle (ie Hamstring, Bicep, Tricep etc) £180

Shoulder £180

Elbow £180

Wrist £180

Hand £180

Hip & Upper Leg £180

Knee £180

Ankle £180

Ankle & Foot £220

Foot £180

Other

Nature of the problem *

Select one, or all that apply

Pain (No Known Injury)

Pain (Caused By Injury)

Lump

Swelling

Other

Tell us more *

Please tell us more about the nature of the problem. Or, if you have selected 'other' in any of the above options, please tell us more here

Duration of symptoms *

How long have you been having this issue?

Have you had any previous diagnostic imaging and / or treatment for this problem *

Eg Previous Ultrasound or MRI Scan, X-Ray, Steroid injection etc

Have you consulted a medical professional about this and have they recommended having an ultrasound scan? *

Yes

If you have consulted a GP, please specify their name and practice address. If you have been consulted by a Physiotherapist, Podiatrist or other medical professional, please state their name, practice address and contact email here.

If you have answered no to the above, Please note we STRONGLY advise having consulted a medical professional before booking this scan as they will be able to advise you if they feel this scan would be of diagnsotic benefit to you and your situation.

What is the clinical question you or your medical professional are hoping to have answered by this scan? Ie muscle tear, tendon tear, joint effusion etc: *

How did you come to know about our clinic or services? ie Word of Mouth, Google Search, Leaflet, Roadside Advertisement, GP/Physio Referral etc *

Thank you! We will assess if a Musculoskeletal and Soft Tissue Ultrasound Scan is right for you based on the information provided. We’ll aim to contact you within 2 working days