Patient

Healthcare Professional

Carer

Step 1: Please complete the form below to register your patient with us.

Step 2: Use the comment box to place your patient's first order and to add any specific requirements. Please indicate product codes, names and quantities.

Step 3: Click Create Account to finalise your patient’s registration. Your patient will then receive a call from our dedicated Customer Care Team.

Please note: Once a patient registration has been finalised, you will not be able to make any changes to the registration.

Register

* - fields are required

Patient Details

Title *

First name *

Last name *

Date of Birth *

Carer 1

Carer 2

Hospital *

Date of Surgery *

NHS Number
(if known)

Are you a
UK resident? *

Telephone 1 *

Telephone 2

GP Surgery Name / Town

Select Treatment
Area *

Laryngectomy
Tracheostomy
Jaw Rehabilitation

Email *

Confirm Email *

Password *
(min 8 characters)

Confirm Password *

Address 1 *

Address 2 *

Postcode *

Town *

Further Information

By creating your account, you agree to Atos Medical using my contact information to process my request and contact me with information about Atos Medical products and services.

Laryngectomy

Tracheostomy

Jaw Rehabilitation

Register

News

We offer a free nursing service to help provide you with support and advice on laryngectomy stoma care and product use.