Section 1: Your organisation

Organisation Data Service (ODS) Code *

Organisation name *

Type of organisation *

Address *

Postcode *

Telephone number * Enter the phone number without any spaces

Section 2: The domain name administrator

Before completing this section please read the description of a domain name administrator.

Read the descriptions https://digital.nhs.uk/services/health-and-social-care-network/hscn-technical-guidance/domain-name-service-dns-guidance/domain-standards-and-guidance/management

Name * First and last name

Telephone number * Enter the phone number without any spaces

Email *

Section 3: The technical contact

Before completing this section please read the description of a technical contact.

Read the role descriptions https://digital.nhs.uk/services/health-and-social-care-network/hscn-technical-guidance/domain-name-service-dns-guidance/domain-standards-and-guidance/management

Name First and last name

Telephone number Enter the phone number without any spaces

Section 4: For domain names visible only on HSCN

Domain name

IP address or CNAME URL

Section 5: For domain names visible only on the public internet

Domain name

IP address or CNAME URL

Section 6: Purpose of registration

Explain the purpose of the site or service you plan to publish * Describe what you’re aiming to achieve. Remember to explain any acronyms or abbreviations used.

*required field

Any personal information you provide will be processed in accordance with the UK General Data Protection Regulation (GDPR). We will use the information to: process your request; and contact you in the even that there is an issue with the domains under your remit; and provide any further relevant information or services you have requested; and support our service development activities