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pHenomenal Health Plan
for discounted fees
(to view all discounts, click here)
4 ways to pay...
1) Pre-Pay OnLine
[CLICK HERE]
OR
2) Print this page, choose how many
treatments you wish to pay for, then
complete the form and send it with your
cheque, made payable to Peter Bartlett
at:
pHenomenal Health, Latymer, Halls Lane,
Waltham St Lawrence, Berks, RG10 0JB
OR
3) Fax the completed form (including your
card details) to us on our secure fax line
(0118 934 4203)
OR
4) Call the clinic with your credit/debit card
details (0118 934 4203)
pHenomenal Health Plan
Pre-payment Form 1
Date:_______/_______/_______
Name:______________________________________________
Address:____________________________________________
___________________________Postcode:________________
Tel. No.:_________________________________
Mobile:__________________________________
Email address:________________________________________
I wish to pre-pay for ________ (1,2,3,4 etc) sessions
with Peter Bartlett at the:
LONDON Clinic
126, Harley Street, W1  Tick box
Hours: Mondays & Thursdays 09.30 - 17.30 or
BERKSHIRE Clinic
Latymer, Halls Lane,
Waltham St Lawrence
RG10 0J Tick box
Hours: Tuesdays & Wednesdays 09.30 - 17.30;
Fridays 09.30 13.30
Please post me confirmation: Tick box or
Please email me confirmation: Tick box
Pre-payment Form 2
PAYMENT: Please refer to the discount schedule
Option 1
I enclose a cheque for £ ______________ or:
Option 2
Credit Card Payment:
Please charge my card: £________________
Name on Card:
.............
....
Type:(Visa, M/C etc):
.....
......
.....
Card No:
.......
.
..........................
Exp. Date:
../
.. 3 digit security code:
...
(Switch only) valid from (if applicable)
/
and Issue No:
..
.
Signed_____________________________________
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