Follow the steps to successfully complete the form.

1. Use the 'Get Form' button to obtain the Uplift Forms For Complex Surgery Bupa and open it in your editor.
2. In section 1, about the customer, provide the required details, including your title, first name, last name, date of birth, address, postcode, and Bupa membership number. Ensure the information is typed and accurate.
3. Move to section 2, about the consultant and hospital. Here, fill in the name of the requesting consultant, their specialty, and the hospital name. Additionally, confirm if you have informed the Bupa patient about the fees in writing.
4. In section 3, procedure information, indicate the reason for the procedure, the date of the procedure, and the names of the performing specialists. Provide the closest CCSD code and expected duration of the procedure.
5. Complete section 4, clinical rationale for uplift request, detailing the justification for the fee uplift based on patient needs and procedure specifics.
6. In section 5, declaration, ensure that the form is signed by the consultant. Include their printed name, Bupa provider number, and the date the form is completed.
7. Finally, check section 6, additional documents, to confirm that any required operation notes and anaesthetic charts are included. Save your changes and prepare the form for submission.
8. After completing the form, you can download, print, or share it. Make sure to submit it via secure fax or a secure email route as specified in the instructions.

Complete your documents online to ensure a smooth submission process.