Referral forms for GPs

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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, St Bartholomew’s, Newham and Whipps Cross 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

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Page 1 of 2 Next page Total results: 28
Title Status Format Description Size Download
Anaesthetic allergy referrals Current doc Anaesthetic allergy referrals for GPs 2MB Download
Autism spectrum disorder assessment service (ASDAS) referral form Current docx Use this referral form to refer to ASDAS in our specialised community children's services 166KB Download
Cancer consultant upgrade request form (Barts Health staff referrals only) Current docx Use this form to upgrade a patient from a routine to an urgent suspected cancer pathway 76KB Download
Cancer single point of referral checklist Current docx Use this form to refer your patient to our cancer services 2MB Download
Cardio-respiratory rehab referral form Current doc Cardio-respiratory rehab referral form for GPs 124KB Download
Complications of excess weight referral form (paediatrics) Current docx 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 31KB Download
Dermatology referral form Current doc Dermatology Referral Form for GPs 114KB Download
Dexa scan referral form Current doc Dexa scan referral form for GPs 100KB Download
Flexible sigmoidoscopy referral form Current doc Flexible sigmoidoscopy referral form for GPs 107KB Download
Gastroscopy referral form Current doc Gastroscopy referral form 117KB Download
Gastroscopy referral form (Whipps Cross Hospital) Current doc Gastroscopy referral form for Whipps only 126KB Download
General allergy referrals Current doc General allergy referrals 47KB Download
Hepatobiliary and Pancreas Cancer referral form Current pdf Form for Hepatobiliary and Pancreas Cancer referrals 455KB Download
HPB severe acute pancreatitis referral form Current pdf HPB severe acute pancreatitis (SAP) referral form 373KB Download
Imaging request form for GPs Current pdf Imaging request form for GPs 82KB Download
Maternity endocrine referral form Current doc Maternity endocrine referral form 57KB Download
Maternity ultrasound referral form Current doc Maternity ultrasound referral form 49KB Download
Musculoskeletal referral form Current rtf Musculoskeletal GP referral form 2MB Download
Neurophysiology request form Royal London Hospital Current doc Neurophysiology request form Royal London Hospital GP 37KB Download
Palliative care referral form Current docx Palliative care referral form GP 110KB Download
Rapid Access Chest Pain Clinic Referral Form Newham Hospital Current doc Rapid Access Chest Pain Clinic Referral Form Newham Hospital 2MB Download
Rapid Access Chest Pain Clinic Referral Form SBH and RLH Current doc Rapid Access Chest Pain Clinic Referral Form for St Bartholomews and Royal London Hospital 1MB Download
Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital Current doc Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital 68KB Download
Rapid Access Heart Rhythm clinic referral form Current doc Arrhythmia clinic referral form 46KB Download
Single point of access form for adult community services Current docx Use this form to refer to the Tower Hamlets community health services for adults 68KB Download
Page 1 of 2 Next page Total results: 28

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.

 
Speciality Hospital Email Phone
Brain and CNS St Bartholomew’s Hospital  Email the team

 

020 7767 3333
Brain and CNS The Royal London Email the team 020 7767 3333
Brain and CNS Whipps Cross Email the team 0208 539 5522 exts 4348/4349/4350
Breast Newham Hospital  Email the team 020 7363 8817
Breast St Bartholomew’s Hospital  Email the team 020 3465 5644

Breast

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