Ward Manager

How To Refer An NHS Patient

Referrers have several options available:

For our detailed Referrer Information Guide please click here.


Colonoscopy Mandatory Referral Proforma

Please print a copy of the mandatory colonoscopy proforma, complete all the details and sign the form. Completed forms should be faxed to  0117 906 1950. To download the form in Microsoft Word format please follow this link. A pdf copy of the Colonoscopy Referral Form for Emersons Green NHS Treatment Centre is available here.

Dental Surgery Referral Form

Please print a copy of the dental surgery referral form, complete all the details and sign the form. Completed forms should be faxed to the relevant treatment centre. To download the form please follow this link.

Urology Referral Form

UKSH offers a comprehensive urology one stop consultation clinic for non-visible (microscopic) haematuria and UTI at Emersons Green NHS Treatment Centre. This is a consultant led and provided service. Our microscopic haematuria service is designed to specifically address the anxieties concerning this finding as promptly and conveniently for the patient and referring GP as possible.

Please note that this service is not for any suspected cancer cases, which should be referred to your local general hospital under the Two Week Wait rule.

Please print a copy of the urology referral form, complete all the details and sign the form. Completed forms should be faxed to Emersons Green NHS Treatment Centre. To download the form please follow this link.

Gastroscopy Referral Form

If you are referring a patient to Emersons Green NHS Treatment Centre, to download a Microsoft Word version of the Gastroscopy Referral Form please follow this link. The form should be filled out in full and returned via fax to the number indicated on the form. 

A pdf copy of the form for Emersons Green NHS Treatment Centre is also available here.

Imaging Referrals

GPs can refer NHS patients to Emersons Green NHS Treatment Centre for direct access ultrasound.  To refer a patient to Emersons Green NHS Treatment Centre using the Imaging Request Form, please follow this link.

For further information about this service please call 0117 906 1861 or e-mail uksh-radiology@nhs.net.

Referral Guidelines

The majority of cases can be treated, however there are a number of exclusion criteria to ensure the safety of all patients. For detailed referral guidelines please follow this link.