REQUEST A SUBSCRIPTION QUOTATION FOR TOXBASE Online for users outside the UK NHS
Please download and complete this form to request a quotation for a subscription to TOXBASE online*
*UK National Health Service users should submit the registration form found on the red ‘Register now!’ link
We do realise that some of these questions may be difficult to answer but please do provide estimate figures as this will help us to provide a realistic quotation.
This form is designed to be downloaded and completed electronically using Microsoft Word.
PLEASE TELL US ABOUT YOURSELF
Title:Initial(s): Surname:
Your job title:
Your email:Please provide a work-related e-mail address
PLEASE TELL US ABOUT THEUNIT/ORGANISATION WHICH WILL USE TOXBASE
Name of unit:
Full address 1:
Full address 2:
Town:
Postcode (or similar):Country: Unit telephone:
Is this unit/organisation:
If you have selected Other please describe
Is this unit/organisation a government/public (not for profit) body?: Yes No
PLEASE TELL US HOW YOU ANTICIPATE USING TOXBASE
Will TOXBASE be used by:please tick all that apply
healthcare professionals treating patients
poisons information specialists giving poisons advice
other - please specify:
Please indicate whether you are seeking:
a single site registrationone login for use by all staff within one unit; suitable for one ED or poisons unit
a multiple site registrationmultiple logins for use by staff of multiple units; suitable for larger organisations
How many staff do you anticipate will use TOXBASE?
How many staff do you anticipate will use TOXBASE simultaneously?
How often do you anticipate requiring access?
Please describe the demographic and size of the population the unit/organisation serves:
Purchase of a subscription grants no rights to use TOXBASE content other than as an information resource to be used by healthcare professionals in the management of poisoning. Please advise if your intention is to use TOXBASE in any other way:
Where did you find out about TOXBASE?
Please use this space to provide any further information you would like to add:
Please indicate if you would be interested in discussing access to NPIS phone services?
Subscription for NPIS phone services may be available at an organisation/countrylevel and is negotiated on a case-by-case basis with our Commissioner at Public Health England (PHE). If you tick the above box we will pass your contact details to PHE who will contact you directly.
Please DOWNLOAD this form to your own computer before completing, and submit as an email attachment to
On receipt your request will be acknowledged and considered by NPIS Edinburgh, the NPIS unit responsible for administering and editing TOXBASE. NPIS Edinburgh is based within and operated through Lothian Health Board.
You can expect an email quotation within 5-7 working days
If you have difficulties downloading or completing the form please email us at for assistance
If you experience any problems emailing this form please print and fax to 0131 242 1387