Family Members (Maximum 3)

Add up to 3 family members who will be covered under this plan.

Email Address * (for digital report access)

Gender
Select gender Male Female Other Prefer not to say

Full Address *

Postcode *

Do you have any known allergies or medical conditions?

Please specify:

Are you currently under a doctor's care for any condition?

Please provide GP/hospital details:

Emergency Contact Phone *

I agree to the 12-month minimum contract and understand early termination fees apply *

I consent to MyScanHub processing my data in line with GDPR and Privacy Policy *

I acknowledge that scans are not a substitute for NHS/GP care *

Full Name (Digital Signature) *
By typing your name above, you are providing your digital signature and agreeing to all terms and conditions.

Register Account