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Bedfordshire and Luton Community Equipment Service Self Assessment Portal
New Account Registration Form


About you

Title
First Name *
Surname *
Date of birth *
NHS Number (if known)

Your address

Door No / Housename *
Street *
Area
Town \ City *
County
Postcode *

Please state which council you pay your council tax to. 

Contact Details (You must provide at least 1 contact telephone number)

Preferred *
Telephone 2 Preferred
Email Address *
Confirm Email Address *

Your assessment portal account login

If you wish, you can create a username here as an alternative to your email address for your login
Username must be at least 8 characters and Password must be at least 10 characters

Use my email address as Username
Password *
Confirm Password *

Millbrook Healthcare Account Agreement

By clicking Create Account, You agree to Millbrook Healthcare's Terms And Conditions and you have read and agree to our Data Use Policy, Including our cookie use.