Refer a client

You will receive £100 per Private Medical referral completion. Simply fill out the following form with your clients details and we will arrange the rest.

Click here to fill out the form

Alternatively email the details to enquiries@ptmedical.co.uk or www.ptmedical.co.uk

Your Details
Name:
Company:
FSA number:
Telephone number:

Client Details
Name:
Telephone number:
Email address:
*Type of cover required: Individual, Family, Single Parent Family, Group
*Smoker: Yes/No
*Date of birth:


* These details are not essential to complete however are helpful to progress the sale.