Referral forms for GPs
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.
Media browser
| Status | Title | Format | Description | Size | Download |
|---|---|---|---|---|---|
| Current | Anaesthetic allergy referrals | doc | Anaesthetic allergy referrals for GPs |
2MB | Download |
| Current | Antenatal care referral form | doc | Antenatal care referral form for GPs |
90KB | Download |
| Current | Antenatal clinical outcome form | Use this referral form to note the outcome and onwards referral details for your antenatal patient |
646KB | Download | |
| Current | Cancer consultant upgrade request form (Barts Health staff referrals only) | docx | Use this form to upgrade a patient from a routine to an urgent suspected cancer pathway |
76KB | Download |
| Current | Cancer single point of referral checklist | docx | Use this form to refer your patient to our cancer services |
2MB | Download |
| Current | Cardio-respiratory rehab referral form | doc | Cardio-respiratory rehab referral form for GPs |
124KB | Download |
| Current | Complications of excess weight referral form (paediatrics) | 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 |
| Current | Dermatology referral form | doc | Dermatology Referral Form for GPs |
114KB | Download |
| Current | Dexa scan referral form | doc | Dexa scan referral form for GPs |
100KB | Download |
| Current | Flexible sigmoidoscopy referral form | doc | Flexible sigmoidoscopy referral form for GPs |
107KB | Download |
| Current | Gastroscopy referral form | doc | Gastroscopy referral form |
117KB | Download |
| Current | Gastroscopy referral form | doc | Gastroscopy referral form |
126KB | Download |
| Current | General allergy referrals | doc | General allergy referrals |
47KB | Download |
| Current | Hepatobiliary and Pancreas Cancer referral form | Form for Hepatobiliary and Pancreas Cancer referrals |
455KB | Download | |
| Current | HPB severe acute pancreatitis referral form | HPB severe acute pancreatitis (SAP) referral form |
373KB | Download | |
| Current | Imaging request form | doc | Imaging request form for RLH/NH/SBH |
148KB | Download |
| Current | Maternity endocrine referral form | doc | Maternity endocrine referral form |
57KB | Download |
| Current | Maternity ultrasound referral form | doc | Maternity ultrasound referral form |
49KB | Download |
| Current | Musculoskeletal referral form | rtf | Musculoskeletal GP referral form |
2MB | Download |
| Current | Neurophysiology request form Royal London Hospital | doc | Neurophysiology request form Royal London Hospital GP |
37KB | Download |
| Current | Palliative care referral form | docx | Palliative care referral form GP |
110KB | Download |
| Current | Rapid Access Chest Pain Clinic Referral Form Newham Hospital | doc | Rapid Access Chest Pain Clinic Referral Form Newham Hospital |
2MB | Download |
| Current | Rapid Access Chest Pain Clinic Referral Form SBH and RLH | doc | Rapid Access Chest Pain Clinic Referral Form for St Bartholomews and Royal London Hospital |
1MB | Download |
| Current | Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital | doc | Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital |
68KB | Download |
| Current | Rapid Access Heart Rhythm clinic referral form | doc | Arrhythmia clinic referral form |
46KB | Download |
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 | 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 |