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ONBOARDING
TEAM DOCTOR

Welcome to The Keyhole Heart Clinic Team Doctor Program. We are looking forward to working with you.

CLINICIAN DETAILS

First Name

Last Name

Email

Telephone Number

CLINICIAN EXPERTISE

General Clinical Expertise

Specialist Expertise

CLINCIAN LOCATIONS

LOCATION 1

Hospital Location 1

Location 1 - Face-to-face clinic days:

Location 1 - Operating Theatre Sessions

LOCATION 2

Hospital Location 2

Location 2 - Face-to-face clinic days

Location 2 - Operating Theatre Sessions

CLINICIAN FEES

New face-to-face consultation Fee

Follow up face to face consultation Fee

New online consultation Fee:

Follow-up online consultation Fee:

INSURED PATIENTS

Please provide a list of insurance providers who recognise your service details and fee arrangements:

BUPA

AXAPPP

AVIVA

WPA

VITALITY

THE EXETER

If you are not fee assured for any of the providers, please provide a list of your fee variance for consultations and procedure codes:

Additional Fee Assured information

PREFERRED DIAGNOSTIC CENTRE INFORMATION

Blood Tests

Cardiology (ECG, Echo, etc)

CT Scan

MRI

ADDITIONAL CONTACT DETAILS

It will be very helpful for us to have a list of essential individuals with whom you would like us to contact when delivering your clinical service. We have listed a few key people who we find extremely useful:

Your NHS Secretary

Out-Patient Booking Team (1)

Out-Patient Booking Team (2)

Theatre Scheduling Team (1)

Theatre Scheduling Team (2)

Diagnostic Bloods

Cardiology Tests (ECG, Echo, etc)

CT Scans

MRI's

Hospital Quotes Team (Self-Pay)

Image IEP Teams

MDT Coordinator

Pre-admission Team

MULTI-DISCIPLINARY TEAM MEETINGS

Please provide details of when and where your preferred MDT takes place:

MDT information

Please let us know any other specific details that you prefer us to undertake for your clinical service here:

Other Details

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