Event Medical Cover Request / Booking Form

Terms and Conditions of Service

Please fill in the form below to receive a quote. This is provided on a no obligation basis, and the terms and conditions of service (viewable by clicking this link) only become effective upon confirming and accepting the booking. Please note that our standard terms of business for payments/invoices are 14 days; a 20% charge will be added for late invoices/payments and by accepting cover, you are agreeing to these terms.

"*" indicates required fields

Contact Information

Company Name*

Event Contact Name*

Email Address*

Contact Number*

Event Information

Address of Event*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Event Start Time*

Event Start Date*

Event End Time*

Event End Date*

Additional Date Information

Risk Assessment : Event Nature

Event Type*

Venue Type

Venue Type*

Audience

Audience*

Full Mix, in Family Groups (2)

Full Mix, Not in Family Groups (3)

Predominantly Young Adults (3)

Predominantly Children and Teenagers (3)

Predominantly Elderly (4)

Full mix, Rival Factions (5)

Past History of Casualties

Past History of Casualties*

Good data, low casualty rate previously (less than 1%) (-1)

Good data, medium casualty rate previously (1% - 2%) (1)

Good data, high casualty rate previously (more than 2%) (2)

First Event, No Data (3)

Event Intelligence

Expected numbers*

Expected Queuing*

Additional Considerations

Time of Year (Outdoor Events)*

Nearest A&E*

Less Than 30 Mins by Road (0)

More Than 30 Mins by Road (2)

Profile of A&E*

Choice of A&E (1)

Small A&E (3)

Large A&E (2)

Additional Hazards*

Returning A B Medical Services Customer*

Yes

Discount Code

Notes / Additional Information

File Upload ( Notes, Risk Assessments etc)

Drop files here or

Max. file size: 256 MB.

Person authorising Booking*

Person / Manager that has authorised this booking

Where did you find us?

Data Protection Agreement

Please click below to consent to A B Medical Services (UK) Ltd holding data about this form and /or inquiries made hereafter in line with the current Data Protection / GDPR legislation. We are registered as a data controller / processor with the UK ICO. A B Medical Services (UK) Ltd will never use your data without consent and will never share this data without explicit consent. Please refer to our full Data Protection policy.

Data protection agreement*

I agree to A B Medical Services (UK) Ltd's Privacy, Data Protection & GDPR Policy (Accessible at the bottom of this page).

Terms and Condtions

Tick this box to confirm that you have read and accept our standard terms and conditions of service (Accessible at the bottom of this page). These will become active at the point of accepting cover in writing or by e-mail with the operations department. Please note that our standard terms of business for payments / invoices are 14 days, a 20% charge will be added for late invoices / payments and by accepting cover, you are agreeing to these terms.

Terms and conditions*

I agree to the terms and conditions

Staff Access

Staff Portal Access

ePCR

Data Protection

A B Medical Services (UK) Ltd may hold data about submissions and /or inquiries made hereafter in line with the current Data Protection / GDPR legislation. We are registered as a data controller / processor with the UK ICO. A B Medical Services (UK) Ltd will never use your data without consent and will never share this data without explicit consent. Please refer to our full Data Protection policy.

Customer Information

Terms & Conditions of Service

Website Terms of Use / Privacy Policy

Complaint Policy

Data Protection Policy (GDPR)

Payments

Client IRF

Call: 03443 100 150

24/7 Contact: +44 (0)7590 542 513

E-mail: operations@ab-medical.co.uk

(UK) In a medical emergency dial 999 or 112