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FOR COMPLETION BY AXA PPP Healthcare PATIENTS

We are pleased to be recognised as an Approved AXA PPP Healthcare Physiotherapy Provider. This means that payment for your treatment fees will be paid by AXA PPP directly to us.

It also means that there are a few new pieces of information that we will need from you before we can start your treatment. The requirements under the AXA PPP Physiotherapy scheme make this information necessary.

When you attend your first treatment, please bring documentary evidence which proves: - that you are a AXA PPP Member - that you have pre-authorised treatment agreed with AXA PPP for physiotherapy treatment - whether you have an excess and if so, how much.

Please complete the form below before your first appointment.

AXA PPP Members Name *
AXA PPP Members Name
Date of Birth
Date of Birth
AXA PPP Members Address *
AXA PPP Members Address
Your name if different to above
Your name if different to above