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NHS GP Referral Form

Please note that this form is delivered securely to an NHS email

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Only an NHS GP Surgery can refer. We do not accept self-referral

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​Please see below (the bottom of this page) if your ICB is affected by the 1-year increase in RTC waiting time.

GP Surgery Information

Referral for:
Upload File
Upload supported file (Max 15MB)
Upload File
Upload supported file (Max 15MB)
Upload File
Upload supported file (Max 15MB)
Upload File
Upload supported file (Max 15MB)

Thanks for submitting!

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Please see below (the bottom of this page) if your ICB is affected by the 1-year increase in waiting time

Important Notice – ICB Funding Caps

Due to funding limits set by certain Integrated Care Boards (ICBs), the current waiting time for Right to Choose referrals in the areas listed below is now around 12 months.

Unfortunately, this delay is outside of our control.

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Affected ICBs:

  • Sussex

  • Leicestershire

  • Bedfordshire, Luton & Milton Keynes

  • Birmingham & Solihull

  • Black Country

  • Frimley

  • Hampshire & Isle of Wight

  • Kent & Medway

  • Norfolk & Waveney

  • Suffolk & North East Essex

  • Greater Manchester

  • Somerset

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