Managed Service Sign Up - ManagedServiceSignUpPage

Your details

Contact name*

Email*

Direct dial*

Surgery details

Surgery name*

Surgery postcode*

Clinical System*

Please enter your Practice's EMIS number (also known as CDB number)* Please enter your Practice's ODS code (sometimes known as NACS code)*

How did you hear about us?*

What made you choose iGPR?*

Why are you taking the decision to outsource?*

Are you happy for iGPR to reference you and any comments included in this form in future case studies and promotional materials about the Managed Service?*

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Choose a plan

Direct Debit

Pricing - £20 per completed report + VAT

We will collect payment for PIP and DLA forms at £33.50 on a monthly basis for each completed report.

Your Managed Service will only begin once you have fully set up your Direct Debit.

We will collect payment on a monthly basis for all reports completed by the Managed Service.

A Direct Debit form will be sent to the details entered below. Please provide details of someone who is able to authorise and set up your Direct Debit.

Account first name*

Account last name*

Company name (optional)

Billing email*

I confirm that the details above are correct*