SecuriCare Tensi+ referral

URL

This field is for validation purposes and should be left unchanged.

Your first name*

Your last name*

Email address*

Phone number*

Which best describes you?

I’m a HCP

I’m a patient/carer

Job title

Hospital / base

Do you have consent from your patient?*

Please ensure you have your patient’s permission before proceeding with referral.

Yes

No

Patient's first name*

Patient's last name*

Address*

Street Address Address Line 2 City ZIP / Postal Code

Phone number*

Email address

Date of birth*

NHS or CHI number

Is SecuriCare CheckIn service required?*

Yes

No

CheckIn is a free additional service available for Tensi+ users. Our Careline Team will call you to see how you are progressing with your treatment and provide any support.

GP name

GP surgery address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

GP phone number

Staying informed about the latest products

I agree

Additionally, we would like to stay in touch with you about related products, news and services. By ticking this box you consent to CliniMed Ltd and our sister-company SecuriCare (Medical) Ltd contacting you for marketing purposes via [email, post, phone (where applicable)].

You have the option to opt out of our email communications at any time by clicking the unsubscribe link in our messages. Please refer to our privacy policy for more details.

Products

Resources

Get a sample

Trusted home delivery for Tensi+

What happens after your referral