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Confirm patient membership details

This is the practitioner, hospital or clinic providing the service

Are you confirming membership details for more than 1 patient?

Enter address manually

First line is required
Town/City is required
Postcode is required
Which system are you using to submit your invoice?

Please note

You need to download the template spreadsheet to provide all of your patient's details. Then upload the spreadsheet below.

Supporting documents

  • You can upload a maximum of 5 files
  • Acceptable file formats include: PDF, JPG, JPEG, PNG, XLS, XLSX, DOC and DOCX
  • Maximum file size must not exceed 5MB