Please provide as much detail as possible and note that items indicated with an asterisk must be completed. To submit your pre-authorisation request click the submission button at the end of this form. You will receive a confirmation email and a member of our claims team will be in contact within 24 working hours, we’re open from 06.00-18.00 (UK Time) Mon-Fri. If you need urgent treatment please click here for information about our emergency service.
Please complete the information requested and include supporting information via the document upload function