The Snowflake Clinic

Personal Information

Please complete the questions that apply to you.

Questions with an asterix (*) must be answered.

Click on the "Browse" button to upload a doctor's referral or any other document directly from your computer or phone. (If needed you can even take a photo of the referral with your phone and then upload the image.)

Thank you for completing this form. When finished, please click or tap the Submit button below and your responses will be sent through to The Snowflake Clinic. If you have not already organised an appointment, someone from our office will be in contact with you within the next three business days.

If you have any queries, contact us by e-mail at