Application for TOXBASE registration

Updated

	TOXBASE is freely available to UK NHS and NHS-affiliated departments, units and practices.

	TOXBASE is used by NHS Direct and NHS 24 but it is not available to individual members of the public.

	Commercial companies and other users, including those overseas, may be allowed access by subscription, subject to the approval of the Health Protection Agency.

	*Please note: TOXBASE usernames and passwords are issued per unit or practice.*

	PLEASE TELL US ABOUT THE UNIT/PRACTICE YOU WISH TO REGISTER

Name of unit/practice:
	* GP users please enter name of practice here
	* Hospital users please enter name of department here

Full address:
	* Hospital users please enter name of hospital here



Town:

Postcode (or similar):

Unit/practice tel:

Unit/practice fax:

Is this unit/practice within the NHS or Ireland?

	If have selected "no" to the above question please tell us about yourself and why you wish to access TOXBASE


	PLEASE TELL US ABOUT THE HEAD OF THIS UNIT/PRACTICE:
	Your unit/practice registration details will be copied to this person

Title:

Initial(s):

Surname:

Their job title:

Their e-mail:
	*Please provide an NHS or other official e-mail address

	PLEASE TELL US ABOUT YOURSELF:

Title:

Initial(s):

Surname:

Your job title:

Your tel:(if different from above)

Your fax:(if different from above)

Your e-mail:
	*Please provide an NHS or other official e-mail address

Where did you hear about TOXBASE?




	If you experience problems sending this form please print and fax to 0131 242 1387