Authorisation Form

Carrying out a review of your current private health insurance arrangements is easy.  All you need to do is download the Authorisation Form (below) and fill in the details as follows:

  1. Print both pages
  2. First page – complete Option 1 and Section 3.
  3. Second page –  copy & paste the wording beneath ?Request to insurer for statement? onto your headed paper, and change the text in bold.
  4. Scan the pages and email them back to or fax to 0116 279 6614.

Once we receive your form and letter, one of our Consultants will call you to discuss your needs and then we will undertake a detailed review of your cover in order to provide you with a full picture of the healthcare market and the options available.
Authorisation Form Download