EAST LONDON

CONTACT US

If you think that you might benefit from a UFE or you just want a second opinion about your gynaecological problem, we would be happy to assist you

Click Here to download  UFE History Form (PDF Document) 

Click Here to download UFE History Form (Word Document)

Uterine Fibroid Embolisation – Patient Assessment

All questions contained in this questionnaire are strictly confidential and will become part of your medical record.

« * » indique les champs nécessaires

All questions contained in this questionnaire are strictly confidential and will become part of your medical record.

Name*
Please select the location closest to you*
Do you suffer from any of the following?*

LIFE St. Dominic’s Hospital

24 St Mark Rd
Southernwood
East London 5213

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