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Patient Forms

Thank you for booking an appointment with LymphVision. Here you will find a selection of forms to complete your booking process. If you're unsure which forms you need to complete please confirm with a member of the team: 0300 180 0112.

Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more.

Self-Referral Form - ICG Imaging

Please complete this self-referral form if you are looking to schedule, or have already booked, your ICG Imaging appointment.

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Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more.

Self-Referral Form - Treatments

Please complete this self-referral form if you are looking to schedule, or have already booked: 

  • Lymphoedema assessment

  • Lipoedema assessment

  • DLT appointment

  • MLD session

  • Any other treatment or clinical assessment

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Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more.

Consent Form - ICG Imaging

You can complete this consent form in advance of your ICG Imaging appointment.

SO Visual - LTA Feb 2026 - 097.jpg

Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more.

Consent Form - Treatments

You can complete this consent form in advance of your appointment with LymphVision.

SO Visual - LTA Feb 2026 - 098.jpg
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