Application Form

Don’t want to fill in our online form? You can download and print your own copy of our application form using the button below. can either fill out an application form online, or download a copy using the button below.

Section A - Your Details

Section B - Contact Details

Section C - Cover

Please confirm the cover you wish to apply for.


Primary Care Scheme

Mandatory Cover - basic level of cover for doctors & nurses consultations, blood tests, consultations at the Emergency Department and essential or emergency ambulance conveyance. For more information please see our brochure.

Additional Benefits Scheme

Optional Add-on Scheme - Cover for other treatments such as minor operations, physiotherapy/osteopathy, allergy testing, ECG's and well person checks. For a full lust of cover provided please see our brouchure.

Major and Critical Care Scheme

Optional 'Add-on' Scheme - Cover for Major and Critical Category treatment within the Accident and Emergency Department of the Princess Elizabeth Hospital. Please see our brochure for full details.


*A three month cover deferment applies for all schemes. This may be reduced or waived at the discretion of the Society.

Section D - Your Medical History

Are you currently suffering from or have you suffered any serious or ongoing illnesses, conditions or injuries in the last 5 years?

Are you currently receiving or expecting to undergo treatment in the near future?

Are you currently receiving or expecting to receive physiotherapy, osteopathy or chiropractic treatment in the near future?

Have you any prospect of undergoing an operation or surgery in the near future?

On average, how often do you visit the doctor/nurse per year (including home visits)?

Section E - Payment Details

Indicate below how you would like to pay for your premium to Foresters Healthcare.

Payment Type




Payment Frequency




We do not issue monthly accounts.

Section F - Other Information


Important

Please read the following carefully

The questions in this application must be answered fully and accurately to the best of your knowledge. You must disclose any material facts or circumstances that would influence the assessment and acceptance of your applciation. Failure to do so may cause the insurance to be declared void. Premiums are based on an annual review and a standard rate is set for each year.

The society reserves the right to charge a non-standard premium rate where applicants have pre-existing medical conditions to represent a non-standard risk based on their medical history.

The society also reserves the right to not accept into membership any applicant that represents an unacceptable risk. Should payments not be received by renewal dates, medical cover will be suspended until such payment is received.

By checking the following boxes you consent to the Society seeking further information to support your application from any Doctor who has at any time attneded you concerning anything which affects your physical or menmtal health, and you also authorise the giving of such information.

Any costs of incurring this information is not payable by the Society. You also consent to the Society providing information to your doctor's surgery, Guernsey Social Services Department, States of Guernsey Health and Social care and any information sought by relevant authorities in the case of a criminal investigation. Information and reports supplied by or to those parties are kept private and confidential and will only be provided to the applicant with prior permission from the party in question.



Data Protection
Due to the nature of Foresters Healthcare business and you wanting to engage with us, we have to ensure that you give us consent to process and hold your personal data. Ticking the following box confirms that you have read and agree to our Data Protection Privacy Policy. Checking the box below is evidence that you give your affirmative consent.