This form is not for authorisation of treatment. Authorisation should be undertaken in the usual way with your patient contacting Customer Service.

For post-operative uplift requests we will need operation notes and anaesthetic charts so we can understand the complications that arose during surgery, and an indication of the fee you wish to charge.

Uploaded documents must be clearly legible; otherwise we will not be able to review your request.

If you need to upload more than one document, please upload your files here