betterhealthcover

• about us
• the product
• FAQs
• contact

Get a quotation from BUPA, AXAPPP, AVIVA and other established private medical insurance companies by completing this form.

When we have received your completed form, we will call and give you useful advice that will save a lot of time and money

Once we know exactly what you are looking for then we aim to send you quotations for the private medical insurance cover you need, within 5 working days.

When is the best time to call you?

AM   PM

*Do you have existing private medical insurance cover?

 No   Yes

1st Adult

*First Name:

*Surname:

*Gender:

 Male   Female

*Date of Birth:

  Smoker:   No   Yes

*Address:

*Post Code:

*Country:

*Email:

*Telephone:

*Where did you hear about us?

2nd Adult

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

  Smoker:   No   Yes

1st Child

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

2nd Child

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

3rd Child

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

4th Child

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

5th Child

First Name:

Surname:

Gender:

 Male   Female

Date of Birth:

Additional
Comments:

*This information is required for an enquiry

Alternatively call Healthtrust for free on 0800 083 4116

“We always like to hear from you.”