TOXBASE access is offered per department or practice. Please enter the full details of the department/practice that you wish to register, then click the "Send Request" button. You will receive a letter detailing your department/practice TOXBASE^® username and password within 2-3 working days.

If you need any assistance filling in this form please ring 0131 242 1381/1383 (weekdays 8am-8pm) or e-mail spib@luht.scot.nhs.uk

Name of department/practice: Full address:   Town: Postcode (or similar): Department/practice tel: Department/practice fax: Department/practice email: Please double check that you have entered your e-mail address correctly.   CONSULTANT IN CHARGE/SENIOR GP OR SIMILAR   Title: Dr Prof Mr Mrs Ms Miss Sister CN Initials: Surname: Their job title: A copy of your department/practice registration document will be copied to this person.   Is this department/practice within the UK NHS: Please ChooseYesNo   NON-NHS USERS: TOXBASE® is available free to UK National Health Service professional users and Accident & Emergency users in Ireland. If you are not within these categories you may be allowed access in exceptional circumstances. Please give details of your reason for wishing to use TOXBASE.   ABOUT YOU   Title: Dr Prof Mr Mrs Ms Miss Sister CN Initials: Surname: Your job title:   Registration documents will be posted out to the head of your department / practice, as named above. They will also be sent to you, at the address specified above, unless you enter an alternative below.   Your full work address: (if different from above)   Town: Postcode (or similar): Department/practice tel: (if different from above) Department/practice fax: (if different from above) Your e-mail: (if different from above) Where did you hear about TOXBASE? poisons service from a colleague previous experience internet browsing from a publication other Other source:     If you experience problems sending this form please print and fax to 0131 242 1387