IMPORTANT: Please read through our Terms and Conditions of service before requesting cover (click this link to open a new page containing our terms and conditions)
Please complete the below fields to request cover for Medical Repatriation / Escort or to transfer a patient.
The fields marked as '*' are mandatory
Hospital / Company / Client Name (of person sending the request) *
Contact Name (of person sending the request) *
Email Address (of person sending the request) *
Contact Number (of person sending the request) *
Patients Date of Birth*
Patients Weight in Kg*
Postal Code *
Date & Time
Urgent / Emergency
Additional Date / Time Information
Transfer Grade *
Family to Accompany*
Medical Staff to Accompany*
Returning A B Medical Services Customer *
Notes / Additional Information *
Person authorising Booking *
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.
Click to accept Data Protection agreement
Click to accept terms
Tick this box to confirm that you have read and accept our standard terms and conditions of service. 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.