Appointment

Kindly fill in this form and we call you back at our earliest to confirm this appointment.

A deposit is taken on some appointments. The deposit is lost if you do not attend any of your appointments without adequate notice, for ANY reason, and you will need another deposit to book another appointment to continue the treatment.

Mobile

Full name

ID Card Nr

Date of Birth

Home Address

Message

legal

THIS IS NOT AN APPOINTMENT. Kindly wait for our confirmation regarding this appointment. The information that I am submitting through this form is my personal data and it is true and correct. I understand that this information is required by MEDIATRIX to process my service request and it will be retained in conformity with the General Data Protection Regulations and policies as established by European Union Law and Maltese Law.