Dott.ssa Nicole Corriette

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Dott.ssa Nicole Corriette

Ilford

Neasden

New Cross

Queen’s Park

Watford

Wembley Central

Wembley Park

Willesden

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Dott.ssa Nicole Corriette

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PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.

NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC)/S1, you may be billed for the cost of any treatment received outside the GP practice, including at hospital).

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