Make an Enquiry

For all enquiries or questions about proton beam therapy at Proton International London, you can call our supportive and helpful team or submit the form below.

020 4629 3598

(9am to 10pm GMT Mon-Fri)

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Thank you for contacting Proton International London regarding proton beam therapy at University College Hospital. We understand that time is of the essence when living with a cancer diagnosis. This form contains all the information we need to determine your eligibility for proton beam therapy. To avoid any delays, please complete as much of the information as possible. We aim to respond promptly to your enquiry.

About you

Your Name(Required)

First Last

Your Email Address(Required)

Your Phone Number

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Enquiring for someone else

I am enquiring on behalf of someone else

Patient Information

First Last

Date Of Birth

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Please confirm your relationship with the patient

Cancer/tumour diagnosis(Required)

What are you requesting from us(Required)

Other

Please confirm the nature of your enquiry

How will you/the patient fund their consultation and/or treatment?

Please upload a recent clinical letter from your current consultant oncologist or doctor to help us respond to you as quickly as possible.

The letter must confirm your diagnosis and any treatment you have already received, such as chemotherapy and/or radiotherapy. Please note you may be required to supply further clinical information upon review by our medical team.

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Accepted file types: jpg, png, pdf, docx, doc, Max. file size: 20 MB.

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Your enquiry

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Please note that if you attach multiple files to our enquiry form, the form may take longer to submit. Kindly click the submit button only once and wait for the confirmation screen. If you are having difficulty sending a request or uploading files, feel free to telephone our helpful team on 020 4629 3598.

Name

This field is for validation purposes and should be left unchanged.

To make a referral for private proton beam therapy treatment:

If you wish to refer yourself or a loved one for private treatment or request a quotation, please use the form above and select ‘Self-referral for a private consultation’.

To help us respond to you as quickly as possible, please upload a recent clinical letter from your current consultant oncologist or doctor. The letter must confirm your diagnosis and any treatment you have already received, such as surgery, chemotherapy and/or radiotherapy. This will be reviewed by our clinical team to assess your suitability for proton beam therapy.

Cancers we treat

About Proton Beam Therapy

Get in touch

Make an enquiry

About you

Patient Information

How would you like us to contact you?

Your enquiry

To make a referral for private proton beam therapy treatment: