Please contact Egress Support via support@egress.com if you have any issues with completing the form. Please do not share personal / medical information with Egress Support, this is for technical support only, relating to completion of the online registration form.

Failed to send your application. Please check your application and try again.

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. It should take a maximum of 20 minutes to complete.

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 Notice.

How is your treatment being funded?(Required)

NHS

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

  • The Hospital you will be treated at
  • The name of your Consultant
  • Your GP information
  • Your NHS number
  • Hospital 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.

Self Pay

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

  • The Hospital you will be treated at
  • The name of your Consultant
  • Your GP information
  • Your NHS number will also be helpful but not essential
  • Hospital 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.

Medical Insurance

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

  • The Hospital you will be treated at
  • The name of your Consultant
  • Your GP information
  • Your insurance company details
  • Your insurance policy number
  • Your authorisation number
  • Your NHS number will also be helpful but not essential
  • Hospital 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.

Registration Form

Which number is this?(Required)
Which number is this?
Which number is this?
We will, in most circumstances, inform your GP of relevant information relating to your care. Are you happy for us to contact your GP? (not applicable to NHS patients)
Do you/the patient have any disabilities?(Required)

Next of Kin Information

Is Next of Kin address same as patient?(Required)
Which number is this?(Required)
Which number is this?
Which number is this?

Admission Information

Is date of visit known?(Required)
Is consultant's name known?(Required)
Has the patient previously attended this hospital?(Required)

Self Pay Information

If this is your first consultation, are you aware of the consultation fee?(Required)
If you have been booked for treatment/tests, has your consultant provided you with the reason for the further treatment/tests and provided you with their fee information for these?(Required)

ALL PATIENTS: I hereby undertake to pay Ramsay Health Care UK Operations limited (Ramsay Health Care UK) for services and materials relating to my treatment as a private patient including in the circumstances where medical insurance proves not to cover the specific course or part of the course of the treatment. This also applies to diagnostic treatments, therefore it is important that you seek clarification from your insurer as to what will be covered in your policy as you will be responsible for any settling. Please be aware that pre-operative tests will be invoiced to your insurance company (where applicable) as Outpatient charges.

Medical Insurance Information

Corporate/Company Scheme?(Required)

ALL PATIENTS: I hereby undertake to pay Ramsay Health Care UK Operations limited (Ramsay Health Care UK) for services and materials relating to my treatment as a private patient including in the circumstances where medical insurance proves not to cover the specific course or part of the course of the treatment. This also applies to diagnostic treatments, therefore it is important that you seek clarification from your insurer as to what will be covered in your policy as you will be responsible for any settling. Please be aware that pre-operative tests will be invoiced to your insurance company (where applicable) as Outpatient charges.

NHS Information

Have you been a resident in the UK continuously for the past 12 months (excluding short overseas holidays or business trips)?(Required)

Communications

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 let us know how you would prefer us to communicate with you:

Tick if Yes Action
Use SMS e.g. text reminders?
Use email?
Use your landline telephone number?
Use your mobile telephone number?
Leave a message on your landline telephone?
Leave a message on your mobile telephone?
indicates required field

To improve our level of care and service; Ramsay is required to monitor patient satisfaction of the services provided to you. We may contact you by email through our third party survey provider, Cemplicity, to ask you to complete a patient satisfaction survey. Please note that we will share your name and email address with Cemplicity to enable them to contact you directly.

To keep you informed about our services; are you happy for Ramsay Health Care to:

Tick if Yes Action
Use SMS?
Use email?
Use your landline telephone number?
Use your mobile telephone number?
indicates required field

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.

Declarations

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 the submission of my registration form - just the same as a pen-and-paper signature and that I agree to the terms and conditions.

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.

Feedback form:
Very easy Easy Average Hard Very Hard Action
How easy was it to find this form?
How easy was it to complete this form?
indicates required field

Data we hold about you

We are committed to 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 Notice.