Expedite Travel Services UNITED KINGDOM ONLINE FORM Call us today +1 (876) 560-5040 / (876) 909-2433 / (876) 553-4282 to speak with a visa specialist for assistance with the form. We are available Monday - Friday 9:00am - 5:00pm Please enable JavaScript in your browser to complete this form.PERSONAL INFORMATION Have you ever been given medical treatment in the UK?Select the correct optionYesNoWere you told that you had to pay the hospital, clinic or doctor's surgery for your medical treatment?Select the correct optionYesNoHave you paid the full amount?Select the correct optionYesNoWhere did you go for your previous medical treatment in the UK?Select the correct optionAccident and Emergency (A&E) at a hospitalTo a doctor, clinic or hospital for non-emergency treatmentName of hospital, clinic or doctors's surgeryAddress of hospital, clinic or where the doctor's surgery was conductedWhat date did you start receiving this medical treatment?MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What date did you stop receiving this medical treatment?MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you still receiving treatment?Select the correct optionYesNoDo you have a UK National Insurance number?Select the correct optionYesNoPlease state your UK National Insurance number belowDo you have a UK driving license?Select the correct optionYesNoPlease state your UK Driver's license number belowHave you received any public funds (money) in the UK?Select the correct optionYesNoEmailSubmit
