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Resolve Health Referral Form

If the mandatory information is not known, please add ‘n/a’ into the respective field.

An automated acknowledgment will be issued following a successful submission. If you do not receive the acknowledgement, please call 01698 207 755 to confirm that the referral has been received.

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  • Insurer/Referrer

  • Insured

  • Injured Party

  • Claimant Solicitor

  • Services Required

  • Please tick all the required services:
  • Please tick all the required invention types:
  • If other selected, please add required investigation below:
  • Medical Report / Medical Records

  • Drop files here or
    Max. file size: 50 MB.
    • This field is for validation purposes and should be left unchanged.