Bupa uplift form 2026

1. Click ‘Get Form’ to open the bupa uplift form in the editor.
2. Begin with Section 1, 'About the patient.' Fill in the patient's title, first name, last name, date of birth, address, postcode, and Bupa membership number. Ensure all information is typed for clarity.
3. Move to Section 2, 'About the consultant and hospital.' Enter the consultant's name, specialty, and hospital name. Confirm whether you have communicated fees to the patient by selecting 'Yes' or 'No' and providing an explanation if necessary.
4. In Section 3, provide details about the procedure including pre-authorisation number, reason for procedure(s), date of procedure, and anticipated operating time. Include any relevant CCSD codes.
5. Section 4 requires a clinical rationale for the uplift request. Use additional pages if needed to ensure thoroughness.
6. Complete Section 5 with your declaration. Sign and print your name along with your Bupa Provider Number. Indicate how you prefer to be contacted regarding funding eligibility.
7. Finally, confirm in Section 6 that all required documents are attached before submitting your completed form via secure fax or email as instructed.

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