Medical Services / Urgent Care / Out of Hours Services

Medical Services Booking Form

"*" indicates required fields

Patient Details

Please call 999 / 111 in an emergency. Please call the Duty Ops number for a quicker response if needed.

Name*

First Last

Sex*

Male

Female

Other

Date of Birth*

Email*

Phone Number ( Include Area code)*

Service Requirements

Type of Service*

Date Requested

Time Requested

:

Address ( Of where the patient is)*

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

Medical Information

Please add as much information as possible to ensure we can provide the right level of care.

What medical care do you need / Current medical complaint ?

Past Medical History (if applicable)

Current Medications and Allergies (if applicable)

Do you or anyone in the household have any COVID symptoms ?*

Yes

No

File Upload - Please upload anything that you feel is relevant for the clinician this can be prescriptions, medical notes, photos etc

Drop files here or

Max. file size: 256 MB.

Where did you find us?

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

Contact Us

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