McAfee Secure sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams

Update Doctor's Details

Please use this form to let us know if you change your family doctor (GP/medical practitioner).

PLEASE NOTE: WE MAY NOT BE ABLE TO PAY YOUR CLAIMS IF YOU DO NOT TELL US WHEN YOU CHANGE YOUR DOCTOR.

Your Details
Your Full Name *  
Your Email Address *   
Your Tel. Number
Your Plan Number *  
Your Member Number *  
   

Your new Doctor's details
Name of new doctor *  
Name of practice, clinic or hospital of your new doctor *  
Address of new doctor *  
Email Address of new doctor  
Telephone number of new doctor *  
Fax number of new doctor
Country where your new doctor is based *  

 

Please tick here if you do not want us to use your personal data to contact you by electronic means (e-mail or SMS) with information about goods and services similar to those which were the subject of a previous sale or negotiations of a sale to you.