Registration Form

When completed click the submit
button and the form will be emailed;

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GP Details

Insurance Details

(please contact your insurance prior to the appointment)

Terms and Cancellation Policy
First assessment consultation (55 minutes) £330.00
Follow up appointment of 30min £230.00
Follow up appointment of 55 minutes £330.00
Prescriptions issued outside appointment : £30.00
• Medical reports will be charged separately
• The client is responsible if insurance fails
• Self-funding patients are required to settle their account at the end of the consultation.
• Dr Bernat will only accept payment by Bacs, cheque or cash. No cards are accepted.
• All financial matters are dealt with by a third party who will contact you on my behalf regarding outstanding payments.
• A 24 hour notice of cancellation is required, otherwise full charges are applicable.
Failure to make payment within 14 days will result in the matter being referred to Debt Collection Agents whose charges will be added to and payable with the invoice debt.

Consent for Information Sharing

It is good medical practice to communicate with other professionals involved in your care so as to ensure the best possible treatment outcomes.

Dr Bernat will discuss with you a wide range of issues. Her normal practice is to prepare a report based on your consultation with a diagnosis and treatment plan to be sent to your GP, Consultant or any other Therapist involved, with a copy to yourself.

Please sign the form, date it and send to me at The Priory Hospital North London if you give consent for information to be shared with professionals involved in your care.

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Please select to accept sharing information and submit form electronically by email to: *