Send a
Referral

A hand written (free text) request on plain or headed paper is acceptable.

Free text referrals will be accepted and must contain:

• patient full name
• DOB
• address
• mobile and email (so we can contact them)
• referrer name
• provider number
• practice name
• practice address
• investigation requested
• clinical details
• preferred method of contact (email or mobile so we can contact you if needed)
• referrer’s signature not required