Register


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Declaration

 By ticking this box, I accept total responsibility for referral of patients to the Bridge Clinic Advanced Imaging centre. I agree that I will not share my username and password with anyone else, including any members of staff and understand that they are for my sole use only.*

 

Instructions

This form is for the use of Medical Practitioners only.

Please ensure you complete all fields. Failure to do so could delay your application being processed.

Your GMC number will be checked when your application is processed, so please ensure your details here enter those on the GMC register.

Please take note of the declaration at the foot of this form. This is a legal declaration to protect patients. Failure to comply with this rule will result in the suspension of your account.