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Your Personal Details

Please fill in your details using the form below to apply for medical indemnity and protection through Indigo.

First name:

Last name:

Preferred salutation:

Email address:

Confirm email address:

Gender:

Mobile number:

Date of birth:

Address

Line 1:

Line 2:

Line 3:

Town / city:

County / region:

Postcode:

GMC number:

Would you like to join CBS?

YesNoAlready a member

Do you have a private practice (other than medicolegal work)?

NoYes

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Please enter your phone number here if you are a robot.

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Please complete this form to obtain a formal quote for NHS practice including Medicolegal income of up to £20,000 pa and an indication of price if your private practice involves surgical procedures. If you want a formal quote for the latter please download and complete and submit the full application form and supplementary questionnaire relating to your specialty which can be found by clicking here.

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