Check a referral form

Complete the online form below to check the status of your referral. You will need a letter of referral from your GP if you would like to see a private specialist or consultant.

Provider's name

Provider's contact details

Patient's full name

Patient's date of birth

Patient's sex

Male

Female

Patient's contact number

Reason for referral

Urgency of referral

Urgent

Semi-urgent

Routine

Preferred date (if known)

Patient history

Brief patient medical history and relevant information for the referral

I confirm that the information provided in the referral is accurate and I authorise the transfer of medical information for the purpose of the referral