Holiday Cancellation Form - The Thornton Practice

PLEASE NOTE YOU WILL BE REQUIRED TO DROP OFF OR EMAIL THE CLAIM FORMS GIVEN BY YOUR INSURER FOR THIS REQUEST TO BE PROCESSED. ([email protected])

Fees apply

Full Name

Date of Birth

Today's Date

Date insurance was purchased (or renewed)

Date you booked the holiday

Date you cancelled the holiday

The dates you were supposed to be on the holiday

Did a health professional advise you to cancel or did you make the decision yourself?

If a health professional advised you, please say who it was and the date the advice was given. Optional

What was the reason the cancellation was needed?

Please tell us anything else you think is relevant Optional