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Hand, Wrist and Elbow Surgery Service
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Skin Surgery Clinic
Travel Health and Vaccination Clinic
Urology Services
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Patient Information
Healthcare Professionals
Book Online
Contact & Find Us
About Us
Services
ADHD and Autism Services
Allergy Testing
Cardiology
Clinical Sciences Services
Colorectal Services
Dermatology
Diagnostics and Imaging Services
Dietetics and Nutrition
ENT and Audiology
Gastroenterology
General Surgery Services
Gynaecology and Women’s Health Services
Hand, Wrist and Elbow Surgery Service
Hepatology
Men’s Health and Andrology Services
Menopause and Perimenopause Services
Mental Health Services
Minor Surgeries
Musculoskeletal Services
Neurology Services
Ophthalmology Services
Oral and Maxillofacial Surgery Services
Paediatric Gastroenterology
Paediatric Mental Health Services
Pain Management
Physiotherapy
Respiratory Medicine
Rheumatology Services
Skin Surgery Clinic
Travel Health and Vaccination Clinic
Urology Services
Women’s Sexual Health Services
Consultants
Patient Information
Healthcare Professionals
Book Online
Contact & Find Us
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Healthcare Professionals
Healthcare Professional Referral Form
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Referrer Details
Patient Details
Preferred method of contact
Telephone
Email
Either
Referral Details
Relevant investigations performed (please see attached results):
Blood tests
Imaging
Risk and Safeguarding Information
Red flag symptoms present:
Yes
No
Safeguarding concerns:
Yes
No
Funding Information
Funding Route:
Self-pay
Insured
Urgency
Referral Priority:
Standard
Urgent
Please do not use this form for emergencies. If you are concerned about immediate risk, use your local urgent or emergency pathway.
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