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Alternatively, please use the form below to request a free, no-obligation quotation . . .

Your Details

Are you a new or existing client?
New client
Existing client
Are you the nominated point of contact for us on the day?
Yes
No
Multi-line address

Service Details

Which service are you enquiring about today?
Time for medical team to be on site
Time
HoursMinutes
Time for medical team to be operational
Time
HoursMinutes
Time for medical team to stand down
Time
HoursMinutes

Address of service provision*

Multi-line address
Is this an indoor or outdoors activity?
Indoor only
Outdoor only
Both indoor and outdoor
Is this a Ticketed Event?
Yes, and tickets will NOT be sold on entry
Yes, and tickets WILL be sold on entry
No, this is an open un-ticketed event
No, this is a closed or private event
Will you have Security present?
Yes
No
Will Security be conducting personal checks or bag checks?
Yes
No
N/A
(Event only) Is the Local Authority Safety Advisory Group (SAG) aware?
Yes
No
Unsure
N/A
Will any of the following "high-risk" activities be undertaken? (Check all that apply)
Will any other specialist support be present? (Check all that apply)
Have you completed your own Risk Assessment? (We reserve the right to request this and we will also provide a medical-specific Risk Assessment for you, however you must still provide your own.)
Yes, already completed
Not yet
No
Ground Type
Is medical staff or ambulance parking available on site?
Yes (Free of charge)
Yes (Charges apply)
Nearby (Off-site) Free of charge
Nearby (Off-site) Charges apply
Other
Is there emergency vehicle access available?
No
Unsure
Yes
Do you have authorisation to conduct this activity (including any landowner or local authority permission)?
Yes
No
Unsure
Have you conducted this type of activity before?
Yes
No, this is the first time
Do you have your own insurance to cover this activity? (We reserve the right to check this. We provide our medical teams with the correct insurance, however you must also have your own).
Yes
Not yet
No
Will you be providing our medical team with radios for communication purposes? (Please note: We may provide our medical teams with their own radios, even if you do not provide any, however they may not be compatible with yours).
Yes
No

Service Provision

What medical-specific resources or equipment do you think you will require? (Check all that may apply)
Please confirm that you have authorisation to request and/or book Ashley James Medical for this proposed activity.
Yes, I confirm I am authorised to engage Ashley James Medical for this proposed activity
Please confirm that you have read and agree to Ashley James Medical's Terms and Conditions of Service (TCoS) available at http://www.ashleyjamesmedical.org.uk/tcos
Yes, I confirm that I have read, agree to, and am bound by Ashley James Medical's Terms and Conditions of Service (TCoS)
Please confirm that you consent for Ashley James Medical to contact you in relation to this online service enquiry
Yes, I consent
How would you like Ashley James Medical to contact you to discuss medical cover for this proposed activity?
Phone only
Email only
Phone or email

If you have any relevant documents about this proposed activity such as Risk Assessments, or Medical Plans from previous medical providers that may help us speed up the planning and provision of our medical services, please upload them here.

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CONTACT US
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Registered Address

Ashley James Medical (PHEC) Limited
Suite 1K, Membury Business Park,
Hungerford,
Berkshire,
RG17 7TJ

Call our expert team today

T: 0330 043 0678

Email us

E: Client.Relations@ashleyjamesmedical.org.uk


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