Appointment Request & Pre‑Triage Form

This form is used to request an appointment and support clinical pre‑triage.

Submitting this form does not confirm an appointment.

Information provided will be reviewed by our reception and clinical team as part of our multidisciplinary triage process, before contact is made with you.

If you require urgent care or an appointment within 48 hours, please telephone reception directly.

1. Patient Identity & Contact Details

2. Patient Status & Triage

Are you an existing British Footcare Group or FOOT CARE patient?

(Required – single choice)

New patients are automatically triaged to ensure clinically appropriate care.

Have you previously been treated for this issue by British Footcare Group or FOOT CARE?

(Single choice)

3. Reason for Appointment / Presenting Concern

What is the main reason you are requesting an appointment?

(Select all that apply)

Brief Description of Your Concern

4. Urgency & Risk Indicators

How urgent does this feel to you?

Is there pain, bleeding, infection, or rapid deterioration?

5. Medical & Safety Screening

Are you currently taking blood‑thinning medication?

(Required)

Allergies & Sensitivities

(Required for safe care and clinical triage)

Do you have any known allergies or sensitivities?

(Required – single choice)

Do you have any medical conditions that may affect foot treatment?

(Select all that apply)

6. Appointment Type Guidance (Patient View)

This selection supports pre‑triage only. Final appointment type is determined clinically.

7. Practitioner Preference

Do you have a preferred practitioner?

Preferences are considered where possible but cannot be guaranteed. Practitioner allocation is determined by availability and clinical suitability.

8. Preferred Location, Timing & Planning

(Operational triage support)

Preferred Clinic Location(s)

(Select all that apply)

Preferred Day(s)

Preferred Time of Day

Health Cash‑Back / Health Plan Information

Do you hold a health cash‑back or health plan that you intend to use for this appointment?

(Single choice)

If yes, would you like us to consider this when discussing appointment options and provide an estimate based on how your allowance may be best utilised?

(Single choice)

Any estimates or guidance provided are indicative only. Patients are responsible for confirming eligibility, cover, and reimbursement directly with their health plan provider. British Footcare Group cannot guarantee reimbursement and accepts no responsibility for declined claims.

9. Multidisciplinary Care Acknowledgement

British Footcare Group- FOOT CARE operates a multidisciplinary team model.

Care may be delivered by a Foot Health Practitioner, Podiatrist, or Clinical Assistant, with clinical oversight and escalation where appropriate, if you have a preference for the specialist you see please let us know when we contact you.

10. Consent & Acknowledgement

(Required checkboxes)

What Happens Next

Your request will be reviewed by our reception and clinical team.

We will contact you using the details provided to confirm a suitable appointment, offer alternatives, or request further information where required.