Online Appointment Form Request

Contact details

Full Name: (required)
Your Email: (required)
Best contact Number:
Patient Case Number:
Are you a new patient?: (required)
 Yes No

Appointment Details

Duration of appointment (required):
 30 Min Standard 45 Min Extended 60 Min Double

  • Recommended for post follow up appointments – you have seen us before
  • New Patients Robin Lansman in Maidenhead
  • Recommended for patients traveling from outside the local area or overseas
  • New patients for Robin Lansman in Maida Vale
  • New Patients for Karen Phillips in Maidenhead
  • Longer New Patient slot Robin Lansman Maidenhead
  • Recommended for patients traveling from outside the local area or overseas

Type of appointment: (required)
 BackPain Orthotics Review standard appointment Pregnancy first appointment Workstation Health Review Thoracic Outlet Syndrome (TOS) Other
If other, please specify

Which Clinic (required):
 Maidenhead W9 Maida Vale

  • Robin Lansman works in Maidenhead on Mondays and Wednesdays
  • Karen Phillips works Tuesdays, Thursdays and Fridays
  • Nandip Sehra works in Maidenhead Mondays 4:30 pm – 6:30 pm and Thursdays 9:00 am – 12:00 pm
  • Robin Lansman works in Maida Vale on Tuesday, Thursday and Fridays
  • Nandip Sehra works in Maida Vale Mondays 10:00am – 2:00pm and Thursdays 2:00 pm – 5:00 pm

Osteopath: (required)
 Robin Lansman D.O. Principle Karen Philips D.O. Senior Associate Nandip Sehra – Associate Osteopath M.Ost

Preferred Date & Time:

Monday- Friday 9:00 - 18:00 (Last appointment -17:30)

Insurance

 I am planning on using Health Insurance

My insurance is with:

If other, please specify

Claim Number

Please Note: Some Health Insurance Companies specify that you must consult a Named Practitioner
Please check that the practitioner you have selected is the one specified.

Important Information

  • After you make your on-line appointment request, you will receive an email confirming your Appointment Time, Date, Clinic Location and Practitioner.
  • Your on-line appointment request will only be responded to within working hours Monday – Friday 9am -5:30pm.
  • Check these details carefully and let us know if there are any discrepancies.
  • Cancellations of appointments normally require 24 hours notice to avoid a fee being charged.
  • Your details will remain confidential and never passed on to a Third Party
  • Body Back-Up is registered with the Data Protection Act.


Extended Appointments
  • Coming from abroad or from across the UK?
  • Got a complex problem?
  • Had a road traffic accident or seen many practitioners?
  • Have X-rays & MRI reports for case review?
  • Or just need more time?

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