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Form Information

Thank you for visiting Ramsay Health Care UK registration. Can you please take the time to carefully complete your details on the following registration form.

Ramsay Health Care UK Operations Limited (“Ramsay”) is committed to ensuring the privacy and confidentiality of your personal information, and to protect it from unauthorised access and disclosure.

In order to provide you with accurate and timely information about your appointments and treatment with us, we will need to contact you, and ensuring we use the best method of communication is vital.

If you have provided a mobile telephone number, you will receive a reminder regarding your upcoming appointments. You are able to ‘opt out’ of this service by following the instructions on your message.

For more information on how we use your data as part of the registration process, please visit our Privacy Policy (please copy link:https://www.ramsayhealth.co.uk/privacy-policy).

How is your treatment being funded?(Required)

Self Pay

Are you attending hospital as an inpatient or outpatient?(Required)

Please ensure you have the following information before you start to complete your details:

  1. The Hospital you will be treated at

  2. The name of your Consultant

  3. Your GP information

  4. Your NHS number will also be helpful but not essential

  5. Patient Number (found on your correspondence from us)

Please ensure you have this information readily available as you will need to complete the form in one session and will not be able to save and return later to complete the form.

Please take time to read our Terms and Conditions here, they contain important information relating to your appointment. These are to be read in association with the patient registration form and will be legally binding terms upon which your inpatient treatment will be provided to you at a Ramsay Health Care UK (Ramsay) hospital or clinic (Hospital).

Please ensure you have the following information before you start to complete your details:

  1. The Hospital you will be treated at

  2. The name of your Consultant

  3. Your GP information

  4. Your NHS number will also be helpful but not essential

  5. Patient Number (found on your correspondence from us)

Please ensure you have this information readily available as you will need to complete the form in one session and will not be able to save and return later to complete the form.

Please take time to read our Terms and Conditions here, they contain important information relating to your appointment. These are to be read in association with the patient registration form and will be legally binding terms upon which your outpatient consultation and treatment will be provided to you at a Ramsay Health Care UK (Ramsay) hospital or clinic (Hospital).

Medical Insurance

Are you attending hospital as an inpatient or outpatient?(Required)

Please ensure you have the following information before you start to complete your details:

  1. The Hospital you will be treated at

  2. The name of your Consultant

  3. Your GP information

  4. Your insurance company details

  5. Your insurance policy number

  6. Your authorisation number

  7. Your NHS number will also be helpful but not essential

  8. Patient Number (found on your correspondence from us)

Please ensure you have this information readily available as you will need to complete the form in one session and will not be able to save and return later to complete the form.

Please take time to read our Terms and Conditions here, they contain important information relating to your appointment. These are to be read in association with the patient registration form and will be legally binding terms upon which your outpatient consultation and treatment will be provided to you at a Ramsay Health Care UK (Ramsay) hospital or clinic (Hospital).

NHS

Are you attending hospital as an inpatient or outpatient?(Required)

Please ensure you have the following information before you start to complete your details:

  1. The Hospital you will be treated at

  2. The name of your Consultant

  3. Your GP information

  4. Your NHS number

  5. Patient Number (found on your correspondence from us)

Please ensure you have this information readily available as you will need to complete the form in one session and will not be able to save and return later to complete the form.

Patient Information

Which number is this?(Required)
Which number is this?
Which number is this?
Have you been a resident in the UK continuously for the past 12 months (excluding short overseas holidays or business trips)?(Required)
Do you/the patient have any disabilities?(Required)InfoRamsay Health Care UK has a responsibility to ensure that the services provided to patients are done so in an equitable and fair manner. Understanding our patients' needs helps us to ensure we comply with those important obligations.
Are you hard of hearing?(Required)
Are you visually impaired?(Required)
Do you have any concerns about your safety at home?(Required)
Do you have any communication problems or special learning needs?(Required)
Is English your first language?(Required)
Are you a current member of the Armed Forces or an Armed Forces Reserve? (Required)InfoAs part of the Armed Forces Covenant, to which Ramsay is a signatory, we like to know if patients are current members of the Armed Forces, the Armed Forces Reserve, a Veteran or a member of the wider Armed Forces’ community (this includes Cadet leaders and immediate family members of Armed Forces personnel). The information will be used to develop resources and policies within Ramsay, as well as ensuring patients are offered appropriate support in line with the Covenant's requirements to the Armed Forces’ family.
Are you an Armed Forces Veteran or a current member of the wider Armed Forces’ community?(Required)InfoAs part of the Armed Forces Covenant, to which Ramsay is a signatory, we like to know if patients are current members of the Armed Forces, the Armed Forces Reserve, a Veteran or a member of the wider Armed Forces’ community (this includes Cadet leaders and immediate family members of Armed Forces personnel). The information will be used to develop resources and policies within Ramsay, as well as ensuring patients are offered appropriate support in line with the Covenant's requirements to the Armed Forces’ family.

Emergency Contact Information

Same Address as Patient
Which number is this?(Required)
Which number is this?
Which number is this?
Would you like to register an alternative emergency contact?
Same Address as Patient
Which number is this?(Required)
Which number is this?
Which number is this?
Is there anyone you do NOT wish us to discuss your care with, if asked?(Required)

Previous Investigations

Have you had any previous imaging/scans e.g. MRI, CT, Ultrasound etc. relating to the condition that you are being referred for?(Required)

Visit/Admission Information

Is the date of visit known?(Required)
Is consultant's name known?(Required)
Have you; or has the patient previously attended this hospital for care?(Required)

Consultation Information

Are you aware of the cost of your consultation/treatment?(Required)

Please contact the hospital to confirm the reason and fee information, or speak with the team when you attend, before you see your health care provider.

Medical Insurance Information

Do you know your authorisation number?(Required)
Is this a corporate / company scheme?(Required)

Declaration

ALL PATIENTS: I hereby undertake to pay Ramsay Health Care UK Operations Limited (Ramsay Health Care UK) for all services and materials relating to my treatment as a private patient. As I am funding my own treatment, I acknowledge that I am personally responsible for settling all charges in full, including diagnostic tests, pre-operative assessments and any additional treatment or services required as part of my care.

ALL PATIENTS: I hereby undertake to pay Ramsay Health Care UK Operations Limited (Ramsay Health Care UK) for all services and materials relating to my treatment as a private patient. I acknowledge that I remain responsible for any charges not covered by my insurer, including diagnostic tests, pre-operative assessments and any shortfall or exclusions under my policy. I am aware that pre-operative tests will be invoiced to my insurance company (where applicable) as Outpatient charges. I understand it is my responsibility to confirm cover with my insurer before treatment.

I have read and agree with the above statement

How we communicate with you

Ramsay Health Care UK Operations Limited is committed to ensuring the privacy and confidentiality of your personal information, and to protect it from unauthorised access and disclosure.

In order to provide you with accurate and timely information about your appointments and treatment with us, we will need to contact you, and ensuring we use the best method of communication is vital.

Please indicate that we are able to contact you in the following ways:

To share information about appointments and your treatment To share information about Ramsay Healthcare and it's services Action
Email
SMS Message
Home Telephone
Can we leave a voice mail?
Mobile Telephone
Can we leave a voice mail?
Work Telephone
Can we leave a voice mail?
indicates required field
Do you require any additional support with communication?(Required)
If yes to the above: Please select all the communication needs which apply

We will only send you marketing information where you have agreed to opt in to receive it. We will only use your preferred communication channels to contact you and you will be given the option to select this when opting in. You can stop us from contacting you for marketing purposes by clicking on the ‘unsubscribe’ link embedded within the email that has been sent to you. Doing so will remove your personal data from our contacts list automatically.

We will always try and use your preferred method of communication, however, there may be instances when we use another of your consented communication options.

Consent

What is your relationship with the patient?(Required)

By clicking submit, I agree that the signature will be the electronic representation of my signature for all submissions of my registration form - just the same as a pen-and-paper signature.

I have read and agree with the above statement.

Data we hold about you

We are committed using your personal information fairly and lawfully. For information about how we collect, use, retain and disclose personal information that we hold about you, please visit our Privacy Policy (please copy link:https://www.ramsayhealth.co.uk/privacy-policy)

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