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FOR COMPLETION BY BUPA PATIENTS

We are pleased to be an Approved Bupa Physiotherapy Provider. This means that payment for your treatment fees will be paid by Bupa 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 Bupa Physiotherapy scheme make this information necessary.

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

Please complete the form below before your first appointment.

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