REFERRAL TO A CONSULTANT

Referring Doctor Details

Name:
Practice Address:
Contact Numbers:
Email address:

Patient Details

Name:
Address:
DOB:
Contact Number:
Email address:

Referral Details

Specialty:
Consultant:
Reason for referral:
Funding:

If the named consultant is unable to see your patient within our target of 7 working days, would you be happy for us to refer to another appropriate consultant?

Submit Referral

We deal with all consultants and all specialties – we aim to place your patient with an appropriate specialist within 7 working days. Thank you for your referral.

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*Some exceptions apply. Contact your Health Insurance Provider for details.

H3 Insurance