Referral Forms for Private Patients

Imaging Request Form

GPs can refer private patients to Shepton Mallet NHS Treatment Centre for MRI, ultrasound and x-ray services. To refer a patient to Shepton Mallet NHS Treatment Centre using the imaging request form, please follow this link.

Please print a copy of the imaging request form, complete all the details and sign the form. Completed forms should be faxed to Shepton Mallet NHS Treatment Centre on 01749 333 740.

For further information about these services please call 01749 333 621 / 622 or e-mail smtc-radiology@nhs.net.