Child Plan - Membership Registration Form

Child Plan - Membership Registration Form
Patient Details:
Full Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
E-mail
example@example.com
Signature to accept terms of the membership agreement
Sign-up for Child Plan Membership
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Child Plan Membership - Monthly Payment
Annual Child Health Check: A 30-minute face-to-face GP appointment for a comprehensive child health check, scheduled at any time within the first 12 months of membership, with subsequent health checks scheduled every 12 months. 6 Face-to-Face or Remote GP Appointments per Year: Your child is entitled to up to 6 face-to-face or remote (telephone/video) consultations with a GP each year, to address any medical concerns. These may be used for both new and follow-up appointments. Free Repeat Prescriptions and School Letters: Repeat prescriptions and medical letters for school or nursery (such as sick notes or attendance letters) will be provided at no additional charge, subject to GP approval. Free Specialist Referrals: If clinically necessary, your child will be provided with free referrals to specialists for further assessment or care. 10% Discount on Additional GP Appointments and Investigations: You will receive a 10% discount on any additional GP consultations and further investigations for your child, such as blood tests, scans, and other diagnostic procedures, where clinically appropriate.

£39.00 for each month
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Child Plan - Membership Registration Form

Sign-up for Child Plan Membership