Arrange a call back

Thank you for telling us you wish to register a claim. Please complete the information requested below and we'll call you back to discuss your claim. Please note this form is for members with health insurance, if you have a cash plan policy please visit this page.

Your Details

Firstname *

Surname *

Date of Birth*

Age:

Policy Number

Please enter the phone number you want us to call you on *

Your Address*

Postcode

Address 1

Address 2

Town/City

County

Your Claim Details

Please briefly describe the nature of the claim, e.g. 'I have been treated in an NHS hospital' or 'I was admitted to hospital in an emergency' or 'I have been referred to a specialist' *

On what date was the incident or the start of the problem? *

Book a Time Slot

We will need to speak with you to progress the claim. Please select a time slot when we can call you.*

Tuesday 16 July	Between 1pm and 8pm	Selected
Wednesday 17 July	Between 8am and 1pm	Selected
Wednesday 17 July	Between 1pm and 8pm	Selected
Thursday 18 July	Between 8am and 1pm	Selected
Thursday 18 July	Between 1pm and 8pm	Selected

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