The Private Care online referral form allows you to refer private patients securely and quickly via an easy to complete form which is sent direct to our private patient bookings team. The system also enables to reduce postage costs whilst being a more secure method of delivery than these older methods.
How can I access the form?
You can access the patient referral form via the following link. You can save this in your browser favourites or create a shortcut from your computer desktop.
You will then be prompted to enter a username and password. This can be obtained by contacting our bookings team email@example.com.
How do I use the form?
Once you have logged onto the patient referral form please enter the patient details and upload any relevant documents for the patient. Once you are you happy you have supplied the necessary information, please press the send button.
Is the form secure?
When you log into our enquiry form portal the session is secure. This means all information will be encrypted before it leaves your PC so that no one else can read it. Whilst the data is in transit we use industry standard Secure Socket Layer (SSL) encryption. We will never ask you to send us personal information via email. Where you wish to discuss such information with us, we will always verify your identity by asking specific security questions.