Form

Due to recent exciting developments to the Diagnostax services, we have changed the way we onboard new customers. We’re now onboarding new customers into Diagnostax in waves.

Slots will be allocated on a first come, first served basis. On receipt of this form, we will notify you of your allocated slot as spaces are limited.

Please note that you can only secure a slot once you have completed a 1-2-1 call with us, we have received a signed e-Form and your GoCardless mandate has been set up. You will only be billed from the 1st of the month, for your allocated onboarding month.

If you would like to get started, please complete your details and we will in contact you with the next steps:

First name*

Last name*

Email*

Company name*

How did you find us?*

Please select a pricing plan*

Please upload a PNG or JPEG, maximum file size 8MB.

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Please provide the HEX code for your main brand colour.

Brand colour (Hex)