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Personal Accident Cover self-referral
This page is for customers who would like to self-refer for physiotherapy and/or wellbeing support as part of their Personal Accident Cover.
Insurance details
Claim number
Accident date
What type of treatment are you self-referring for?
Physio
Wellbeing support
Your involvement
- Please confirm your involvement in the claim -
Named driver
Policy holder
Policy holder's spouse/partner
Please speak with your insurer if you are not one of the above.
Customer details
First name
Surname
Date of birth
You must be at least 17 years old to access this service
Phone number
Email address
Address
Address
City/Town
Postcode
Physio referral
Is this a new injury?
Yes
No
Injury area
Injury details
Wellbeing support referral
Symptom details
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