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 [email protected] 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