Adult Appointments

Book an appointment

Book a circumcision appointment with the Circumcision Centre Wales. All appointments take place at our purpose fitted clinic in Cardiff, South Wales.

Please fill out all required information on this form.

Please ensure all information is accurate, as this information will be used to create your booking and send out appointment correspondence and other important information.

A member of staff will be in touch within 24 hours to complete your booking.

Full Name *

Date of Birth *

Address 1 *

Address 2 *

City *

Post Code *

Phone number *

Email *

What is your reason for wanting circumcision? *

How far can you retract your foreskin? *

Do you have any current illnesses or medical conditions *

If yes, which medical conditions do you have?

Do you have, or is there any family history of bleeding disorders, or are you on any blood thinning medication? *

Please list any regular medication here (if applicable)

Have you ever had penis filler injections at any point in the past? *

If there is anything else you would like to tell us, please do so here

Finally, how did you hear about us? *

Please leave this field empty.

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