MyMedicalChoice – Positiv ID

Name*

Name of person ordering card(s)

Contact Phone Number

Will only be used if clarification of details is required. No details are stored.

Contact Email Address

Will only be used if clarification of details are required. No details are stored.

Address for delivery of cards (Billing address when buying multiple cards)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please enter the address you would like the cards delivered to. This should also be the billing address when buying multiple cards. There is an option to add a different shipping address during the payment process.

How many individuals require cards?*

You can select the quantity of cards for each person in the steps below. The first card cost just £3.00p. Additional cards cost £2.50p each.

Postage*

How would you like us to post your cards to you? All cards will be posted to the address given during payment.

Card 1

Name*

The name saved in your My-Medical-Choice.org personal account page. This will be printed onto your card(s).

Date of Birth*

Card Type*

Please choose which type of card you would like printed, from the drop down options. You can select either Medical ID Card, No Blood Card, or choose to have both cards printed (at a discounted rate).

Passcode*

This is the Passcode issued to the named person when subscribed to My Medical Card. As saved on the My-Medical-Choice.org personal account page. For more information please visit https://www.my-medical-choice.org

ICE Name 1

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 1:

Please enter the contact phone number for the above named person.

ICE Name 2

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 2:

Please enter the contact phone number for the above named person.

How many copies of Card 1 do you require?*

Card 2

Name*

The name saved in your My-Medical-Choice.org personal account page

Date of Birth*

Card Type*

Please choose which type of card you would like printed, from the drop down options. You can select either Medical ID Card, No Blood Card, or choose to have both cards printed (at a discounted rate).

Passcode*

This is the Passcode issued to the named person when subscribed to My Medical Card. As saved on the My-Medical-Choice.org personal account page. For more information please visit https://www.my-medical-choice.org

ICE Name 1:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 1:

Please enter the contact phone number for the above named person.

ICE Name 2:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 2:

Please enter the contact phone number for the above named person.

How many copies of Card 2 do you require?*

Card 3

Name*

The name saved in your My-Medical-Choice.org personal account page

Date of Birth*

Card Type*

Please choose which type of card you would like printed, from the drop down options. You can select either Medical ID Card, No Blood Card, or choose to have both cards printed (at a discounted rate).

Passcode*

This is the Passcode issued to the named person when subscribed to My Medical Card. As saved on the My-Medical-Choice.org personal account page. For more information please visit https://www.my-medical-choice.org

ICE Name 1:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 1:

Please enter the contact phone number for the above named person.

ICE Name 2:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 2:

Please enter the contact phone number for the above named person.

How many copies of Card 3 do you require?*

Card 4

Name*

The name saved in your My-Medical-Choice.org personal account page

Date of Birth*

Card Type*

Please choose which type of card you would like printed, from the drop down options. You can select either Medical ID Card, No Blood Card, or choose to have both cards printed (at a discounted rate).

Passcode*

This is the Passcode issued to the named person when subscribed to My Medical Card. As saved on the My-Medical-Choice.org personal account page. For more information please visit https://www.my-medical-choice.org

ICE Name 1:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 1:

Please enter the contact phone number for the above named person.

ICE Name 2:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 2:

Please enter the contact phone number for the above named person.

How many copies of Card 4 do you require?*

Card 5

Name*

The name saved in your My-Medical-Choice.org personal account page

Date of Birth*

Card Type*

You can select either Medical ID Card, No Blood Card, or choose to have both cards printed (at a discounted rate).

Passcode*

This is the Passcode issued to the named person when subscribed to My Medical Card. As saved on the My-Medical-Choice.org personal account page. For more information please visit https://www.my-medical-choice.org

ICE Name 1:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 1:

Please enter the contact phone number for the above named person.

ICE Name 2:

Please enter the name of the person to be contacted in case of emergency.

ICE Tel 2:

Please enter the contact phone number for the above named person.

How many copies of Card 5 do you require?*

Total

£ 0.00

Please check all details are correct before submitting the form.*

I confirm that all details entered are correct.

Cart

Card types:

Card 1

Card 2

Card 3

Card 4

Card 5

Total