MRI Referral Portal Account
(for items requiring standard post)
Confirmation of your registration and logon details will be sent
to the email address provided
in this form.
Please note: The information you provide
in this form will only be used by the Cheltenham
Imaging Centre and will not be passed on to
any 3rd parties without your consent.
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Cobalt Health, a registered charity no. 1090790.
Company limited by guarantee, registered in England no. 4366596
Registered office: Linton House Clinic, Thirlestaine Road, Cheltenham,
Glos GL53 7AS
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