Please visit the NHS e-Referral Service page for a list of our services that are excluded from e-Rs and the secure email addresses you will need to refer to.

Breast Services

Breast Pain Clinic Referral – The Nelson Health Centre


Cardiac Investigation Referral Form SGH May 2019

Cardiology QMH Referral Form May 2019

Cardiac prevention and Rehab Referral Form Nov 2019

Cardiology Diagnostics Referral Form Adult Sept 2020

Rapid Access Chest Pain Referral Form May 2019

Rapid Access Heart Failure Referral Form May 2019

Children’s Services

Paediatric Rapid Referral Form Dec 2018

Tongue tie Frenulotomy referral form Aug 2019

Community Services

Assistive-Technology-Referral-Form – June 19

Bader Gym Referral Form

Integrated Falls Service Electronic Referral Form October 2019

Multiple Sclerosis CNS Referral Form May 2019

SJTC Community Dietetics Referral Form Dec 2018

Specialist Spasticity Management Service Referral Form Dec 2018

Special Seating Initial Referral Form QMH May 2019

Special Seating Review Referral Form QMH May 2019


Diabetic Foot Clinic Referral Form Jan 2019

Diabetic Foot Clinic A&E Referral Form Jan 2019


Referral to SWL ENT Emergency Form 2023


Digestive Hub Rectal Bleeding Referral Proforma


Colposcopy outpatients referral 

Neurology / Stroke

Community Migraine Advice Clinic referral Form

First Fit Referral Form

Neurology Rapid Access Clinic Referral Form

Transient Ischemic Attack (TIA) Referral Form

For further information on Neurosciences services, please click here.


Craniospinal Trauma Referral Form

MSCC referral form May 2016  (For more information about Metastatic Spinal Cord Compression click here)

Neurovascular MDTM Referral Form

Pulmonary Rehabilitation

Pulmonary Rehabilitation Form September 2023


MSK Single Point of Care Access Referral Form August 2021

Physiotherapy Musculoskeletal Referral Form Single Point of Access 2021

Staff physiotherapy referral form June 2019

Paediatric Physiotherapy referral form

Physiotherapy non MSK referrals June 2019

To refer to Pelvic Health Physiotherapy please refer via ERS [GP] or via powerchart [internally]

Respiratory Outpatient Referral Form 


CT headache Referral Form QMH May 2019

MSK Rheumatology Corticosteroid Guidance June 2020

Planned Care Headache Pathway May 2019

Radiology Referral Form November 2022

Steroid injections Temporary Pathway- COVID period 2020


Brysson Whyte Rehab Unit Referral Form Oct 18

Functional Electrical Stimulation QMH referral form June 19Roehampton Rehab Referral Form 2019

Gait Lab Referral Form QMH June 2019


Bone Densitometry DEXA Referral Form July 2019

Trauma and Orthopaedics

Fracture clinic:

For GP referrals, please refer via e-Referral Service

For tertiary referrals please complete the form below and send to 

Trauma and Orthopaedics Tertiary Fracture Referral Process Nov 2018


Shoulder Referral Proforma Nov 18

SGH Shoulder Unit Aid to diagnosis and management Nov 18