Preliminary Consultation Form

The Online Preliminary Consultation is a service offered to patients located outside the United Kingdom. It is designed to provide potential patients with general feedback and information in order to better decide whether to seek care in our office.

Please take time to fill out all questions on the form carefully and completely.

Dr Sorensen will review the submissions and determine whether you appear to be a suitable candidate for treatment. Your submissions will be followed up by a phone call from our staff within one working week.

Please take special care in ensuring that photos you submit are of good quality and are made in accordance with the photo quality/size guidelines.

[Terms and Conditions]

[Photo Guidelines]

Title
First Name
Last Name
Address
Postcode
Country
Email
Telephone
Best time to call
Profession
Date of birth
Weight
Height
Smoking
Do you have any known allergies?
Do you take Aspirin, Ibuprofen, Nurofen, Fish Oil, Flax Oil, Omega Oil or Vitamin E?
Medications taken
Alternative or herbal medicines
Do you have any general health problems or conditions?
Have you received treatment for depression or anxiety?
Please list previous surgical procedures, approximate dates and outcomes
Do you usually heal well after suffering minor wounds?
Do you usually have prolonged bleeding after suffering minor wounds?
What type of surgery are you considering?
Please describe as specifically as possible the nature of your concern and desire for surgery
Please describe your expectations from surgery
Do you have any particular concerns regarding the surgery?
Have you already seen another doctor regarding this surgery? If yes, please note their recommendations?
Do you have an approximate time period in mind for your visit?
Will you be traveling alone?
Where will you be residing during your stay?
Do you have any special requirements we should know about?
Is there any other information you wish to share with us now?
Do you understand and accept in full the terms and conditions of use for the online preliminary consultation form.
Please type your full name to confirm that the enclosed information is accurate and complete.
Attaching Photos
You may attach up to 5 photos from your computer. Please review our guidelines and the photo quality/size requirements before attaching your files.
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Note: If for any reason you are unable to attach images to the form, you may email them separately along with a brief message clearly identifying yourself and the
Submitting your form
If you wish to save a copy of this form, please print now before submitting.

We specialise in plastic surgery, cosmetic surgery, reconstructive surgery of the face, microsurgery, eyelid and oculoplastic surgery, facial nerve surgery, breast surgery and breast augmentation.

Our skin specialists treat a wide range of skin conditions through a combination of therapies, including microneedling, skin peels, injectables, dermabrasion and Obagi skin care products.

Sorensen Clinic
Plastic and Reconstructive Surgery
10 Knaresborough Place
Kensington
London SW5 0TG
United Kingdom

Appointments: +44 (0) 20 7600 4444 | infoEmail protection@Ignore thissorensenclinic.com

Sorensen Clinic
Plastic and Reconstructive Surgery
10 Knaresborough Place
Kensington
London SW5 0TG
United Kingdom

Appointments: +44 (0) 20 7600 4444
Email: infoEmail protection@Ignore thissorensenclinic.com

Office hours

Monday - Friday: 09.00 - 17.30

Attaching Photos

Submitting your form