Please complete the medical questionnaire below In order to register with the practice. There is a fee of £100 for registration. When you have completed the questionnaire you will be directed to a payment page where you can enter your credit/debit card details.

All information received will be treated in strict confidence in accordance with GMC regulations and not be divulged to any third party without prior consent.

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General Info

COMPANY PATIENTS: We recommend that any report and test results sent to you following a medical is forwarded to your own NHS general practitioner.


Lifestyle


Medical History

Please detail any complaints you have relating to your:


The detail you have given on this form will be entered into and held on our computer system. It will not be shared with any other organisation and will be used only to enhance the service offered to you by the practice in accordance with the Data Protection Act (registration Z5224059)


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Nick and Sophia are top professionals with a comprehensive network of specialists, should they be needed, in the vicinity of Harley street. I have seen a number of them and all have been “top quartile” in my opinion.
Jim Ratcliffe, INEOS
48 Wimpole Street practice has taken outstanding care of my family for three generations. They are a fantastic team, from the doctors to the practice staff. I am always confident that we receive the best of care and advice.
Shrai Madhvani
I have been visiting the Wimpole Street practise for 10 years now and can honestly say the level of service I have received is second to none. Sophia and her team always go above and beyond to ensure their patients receive the warmest welcome and …
James Myers, Group Managing Director TVC Group
I have been both a patient of Dr Khalique’s and she has worked with us in our business for a number of years. I and my team have been constantly impressed with her medical expertise, professionalism and caring manner. She is supported by terrific staff …
Sara Geater
Dr Khalique provides invaluable professional support to Thames. The Practice at 48 Wimpole Street is integral to the screening and welfare of contributors taking part in our highest profile television programmes. The consultancy provided to our productions ensures that we can offer the best and …
Dean Jones. Director of Production, Thames
I have and our company has been a patient of Dr Sophia Khalique’s and ’48 Wimpole Street’ for 15 years. She and her team are fantastic; they have a wonderful manner, truly care about their patients, are totally professional and give great advice. We use all their facilities …
Nick True Chairman TLC Marketing Worldwide
As a family, we are very content with the services we have received from the practice of Dr Sawyer and Dr Khalique. The caring and accommodating staff have always been assuring to any urgent need we have had in the past. For a small practice …
Fauziah and Jeremy Robinow
For me Sophia has been a constant presence and support through a couple of particularly torrid and potentially (but not yet!) terminal years. Consultants are highly focused and knowledgeable doctors, but they cannot generally, and do not, provide the sort of constant holistic care that …
John Stephens, Barrister, Lincoln’s Inn
Having known Dr Khalique for fifteen years, we have developed a great relationship as she has seen me grow up and been with me every step of the way to make sure I became the healthy, happy person I am today. Most people my age …
Yasmin, First year student at Bristol University
Having experienced the service provided by Nick and Sophia, Timothy James & Partners recommend all important clients’ medicals be carried out by their practice. It is efficient and we stay in control of the paperwork and medical underwriting. Many of those clients that have been …
Timothy Whiting, Timothy James & Partners
Dr. Nick Sawyer has kept us in good health for more than 15 years. He has always been kind and caring and referred us to top specialists whichever care has been our need. We are always confident that whatever the reason for our visit we …
Philipa and Michael Bradley
Sophia Khalique has been our family doctor for the past fourteen years. She has not only seen us through the birth of my youngest son and the usual childhood and adult ailments but also through major illnesses, both chronic and acute. Sophia has been our …
Mrs M Jay and Mr R Pyke
I have known Dr Khalique for many years. She has all the qualities of a top doctor. She has compassion and sympathy in addition to being extremely competent professionally. She is a joy to work with and has a lovely bedside manner. I would heartily …
Dr Charlie Cockerell
The Bechtel Corporation have relied upon Dr. Sawyer for the past 25 years and Dr. Khalique for 15 years for medical services that include pre foreign assignment medicals, executive medical evaluation, preventative services, medical risk assessments and all manner of GP services. We work all …
Rob Bull, HR Manager, Bechtel Corporation
I have the great pleasure in being both a personal patient of Dr Sophia Khalique and of having a professional relationship with her and her practice at 48 Wimpole street for Medical and psychiatric pre-care and after care for the contestants that audition and appear …
Richard Holloway, M.D. Thames Television. Interim C.E.O. Fremantle Media U.K.