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Emergency Request

  • Please complete your personal information and your reason for an emergency appointment. We consider each request individually.
  • Do not forget to "tick" the box at the bottom of this form to register in the waiting list.
  • By including your name in the waiting list you will be notified , by email, when there is availability for the category you have requested.
  • Receiving a notification email does not mean you necessarily have a confirmed appointment. You must follow the procedure in order to book an appointment.
  • The notification of availability is sent to all members of the waiting list simultaneously, without priority.
  • You must fill in all fields of the form. If you click "Submit" and you get an error message, that mean that you need to complete the fields that appear inside a red frame.
Category:  
First name:  
Last name:  
Email:      
Confirm Email:    
Phone:  
Reason:  
Please add me to the wait list for this category, so if an appointment becomes available if the next days, I'll be instantly notified via email.