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Switch clinic

Start your transfer

Tell us about your current clinic, prescription and GP. With your consent we will request your records, then a specialist doctor on the GMC Specialist Register will review your care.

Your details

Fields marked with an asterisk are required.

Your name

Email address

Phone number (optional)

Your current care

Current clinic

What you are currently prescribed, with doses

Date of your last prescription

Your GP

GP practice name

GP practice address (optional)

I consent to Jorja Essex Ltd requesting my letters and prescription history from my current clinic, and a summary of my diagnosis and past treatments from my GP.

I am happy for Jorja Essex Ltd to hold my details and contact me about my transfer.

Your current treatment is not automatically continued. All treatment is subject to clinical assessment and eligibility.