Skin Surgery Clinic

Award-Winning Dermatology and Plastic Surgery in Leeds and Harrogate

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Self Referral

Here you can download our Patient Self Referral form (PDF format).

Alternatively, call us on 01943 882 011 or email info@skinsurgeryclinic.co.uk.

Online Consultation

Complete this form to be booked straight in for your procedure

Name*
Forename Surname
Date of Birth*
Date Format: DD slash MM slash YYYY
Email Address*
Enter Email Confirm Email
Phone Number*
House Number / Name*
Postcode*
Which clinic would you like to attend?*
Treatment of Interest*
You might need an in-clinic consultation.

Some procedures require an initial appointment with your Surgeon before treatment. You can still use this form and we will call you back to discuss next steps, but before proceeding to treatment you will need to book an in-clinic consultation with one of our Surgeons.

For the following treatments, please call to book an appointment:
- Rhinophyma treatment
- Earfold Prominent Ear Correction
- Earlobe Reduction
- Inverted Nipple Surgery
- Upper Blepharoplasty
To book, call 01943 882011.
Upload photos*
Please upload clear image(s) of the area for our medical staff to review.
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tiff, pdf.
How long have you had this condition?*
Any recent changes in your condition?*
Current and past medical history*
Are you using any medications?*
(prescribed and over-the-counter)
Do you have any allergies?*
How did you hear about us?*
View Terms and Conditions
*
- I agree to the terms and conditions
Comments
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Our purpose-built clinic in Leeds
Free parking on site

Care Quality Commision
Click here to read the latest CQC report on the clinic

Within easy reach of

Leeds
York
Ilkley
Colne
Otley
Halifax
Ripon
Hull
Bradford
Harrogate
Wakefield
Horsforth

Roundhay
Barnsley
Doncaster
Keighley
Manchester
Chapel Allerton
Sheffield
Rotherham
Hebden Bridge
Boroughbridge
Knaresborough
Huddersfield

Skin Surgery Clinic

info@skinsurgeryclinic.co.uk

78 Back Lane

Guiseley

Leeds

West Yorkshire

LS20 8EB

Information

Terms & Conditions

Accreditation

Good Skin Days met all of the standards at our most recent CQC inspection

Read the report here >

Keep in Touch

*DISCLAIMER: Surgery results and benefits can vary and are different for each individual. As such, Skin Surgery Clinic cannot guarantee specific results.