Referral forms for GPs

Computer with keyboard and office chair

Where possible please use the Electronic Referral System (e-RS) to make a referral. Only if e-RS is not available should you email a referral form to us or contact us.

Referral forms are available to download here for services at The Royal London, Mile End and St Bartholomew’s hospitals.

If you are looking for the pan-London Urgent Suspected Cancer (USC) referral forms (previously known as Two Week Wait referrals), please try e-RS in the first instance. Word versions of the form can be downloaded here.

Download a referral form

 

Download referral forms 
Referral form in Word Referral form in EWDT
Cancer  

Cancer single point of referral checklist 2MB

Cancer consultant upgrade request form (Barts Health staff referrals only) 73KB

  
Cardiology  
Rapid Access Chest Pain Clinic Referral Form Newham Hospital ewdt not available
Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital  
Rapid Access Chest Pain Clinic Referral Form St Barts / Royal London Hospital  
Rapid Access Heart Rhythm clinic referral form 46KB ewdt not available
Cardio-respiratory rehab referral form 124KB ewdt not available
TAVI inpatient referral form [docx] 319KB  
Dental and OMFS  

For all referral forms visit our dental website

  
Dermatology  
Dermatology Inpatient Referral Form - Whipps Cross Hospital  
Digestive disease  
Gastroscopy referral form 117KB  
Gastrocopy referral form (Whipps Cross only)  
Flexible sigmoidoscopy referral form 107KB  
Hepatobiliary and Pancreas Surgery  

HPB severe acute pancreatitis referral form 373KB

  
Hepatobiliary and Pancreas Cancer referral form 455KB  
Imaging  
Imaging request form 148KB - RLH/NH/SBH ewdt not available
Imaging request form 113KB - Whipps Cross Hospital   
Dexa scan referral form 100KB ewdt not available
Maternity  
Maternity endocrine referral form 57KB  
Maternity ultrasound referral form 49KB  
Antenatal care referral form 90KB  
Clinical outcome form from the antenatal clinic[pdf] 646KB  
Musculoskeletal  
Musculoskeletal referral form 2MB ewdt not available
Neurophysiology   
Neurophysiology request form RLH 37KB  
Palliative care  
PallE8 referral form 392KB  
Paediatrics  

Complications of excess weight referral form (paediatrics) [docx] 31KB

This is targeted support for a small number of young people with severe complications due to excess weight who are engaged and ready to make holistic lifestyle change.

  
Respiratory medicine  
Anaesthetic allergy referrals.doc [doc] 2MB  
General allergy referrals.doc [doc] 47KB  
Tower Hamlets Community Health Service  
Tower Hamlets Children’s Services Referral Form (SPA form)   
Tower Hamlets Children’s Services Referral Guidance  
Tower Hamlets Autism Spectrum Disorder Assessment Service (ASDAS) Referral Form  
Tower Hamlets ASD Assessment Referral Guidance   

Urgent cancer referrals

The Electronic Referral System (e-RS) is the preferred booking method for suspected cancer referrals. Only if e-RS is not available should you email a referral form to us.

These contact details should be used by GPs and primary care healthcare professionals for urgent suspected cancer patient referrals only.

Contact details by speciality
Speciality Hospital Email Phone
Brain and CNS St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net

 

020 7767 3333
Brain and CNS The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Brain and CNS Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Breast Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Breast St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 3465 5644

Breast

 The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 3465 5644
Breast Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Children Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  0207 363  9390
Children St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Children The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Children Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350;
07917 093739 – Urgent Cancer On call 
Gynaecology Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Gynaecology St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Gynaecology The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Gynaecology Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Haematology Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Haematology St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Haematology The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Haematology Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Head and Neck St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Head and Neck The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Head and Neck Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Lower GI Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Lower GI St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Lower GI The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Lower GI Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Lung Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Lung St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Lung The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Lung Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Ophthalmology The Royal London (RETINOBLASTOMA) bhnt.London_Retinoblastoma@nhs.net  0203 594 1419
Skin St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Skin The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Skin Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Upper GI Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Upper GI St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Upper GI The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Upper GI Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350
Urology Newham Hospital  bhnt.2WWappointmentsbartshealthNUH@nhs.net  020 7363 8817
Urology St Bartholomew’s Hospital  bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Urology The Royal London bhnt.2WWappointmentsbartshealthBLT@nhs.net  020 7767 3333
Urology Whipps Cross bhnt.2WWappointmentsbartshealthWX@nhs.net  0208 539 5522 exts 4348/4349/4350