General Consultation Form

The general consultation form securely collects your medical history, current symptoms, medicines and contact details before a private doctor appointment. It is for adults who need assessment of a health concern and want to give the clinical team the information required to plan an appropriate consultation.

Complete Medical Assessment

Please fill out this comprehensive form to help us understand your medical history and current health concerns. This information will help our doctors provide you with the best possible care.

Confidential
Secure
Comprehensive

Consultations are provided from 8 Harley Street, London W1G 9PF. A standard Private GP appointment is £50 for 20 minutes or £75 for 30 minutes, and same-day availability may be offered subject to confirmation.

NICE guidance on discussing treatment options and shared decisions

Key facts

  • Price: £50 for 20 minutes or £75 for 30 minutes; additional tests discussed separately.
  • Duration: 20 or 30 minutes for a standard private GP appointment.
  • Who it's for: Adults requesting a private assessment of a health concern; not an emergency service.

Personal Details

Please provide your personal information for our records

Medical History

Please provide information about your medical background

Gynecological/Obstetric History

For female patients or if applicable (optional section)

Check this if you need to provide gynecological/obstetric history

Current Concern & Reason for Visit

Please describe why you are seeking medical consultation today

Lifestyle Factors

Information about your lifestyle helps us provide better care

I understand that this information will be used to provide medical care and may be shared with healthcare professionals involved in my treatment. I confirm that the information provided is accurate to the best of my knowledge.

Connected care at PrivaDr

Use this form when you are ready to provide details for a medical consultation. You can first review our Private GP service and common conditions guidance. For preventive screening, see VitalMan or VitalWoman; visitors to London can also use our international patient service.

Frequently Asked Questions