Referral forms
Various King’s specialties require you to complete specific referral forms to accompany the referral documentation that you email to us. We have collated the latest versions of these forms here, for your convenience. They can also be downloaded from the referral information section of the relevant department in the services directory.
For more details and advice, read our guidelines on referring patients to King’s.
| Title | File Size | Link |
|---|---|---|
| 12 lead ECG referral form | 39 KB | |
| 24HR BP monitor referral form | 36 KB | |
| 24HR ECG monitor referral form | 38 KB | |
| Advanced Chronic Liver Disease MDM referral form | 268 KB | |
| Antenatal GP and medical referral form | 259 KB | |
| Cardiac diagnostics – Event Recorder referral form | 38 KB | |
| Cardiac Rhythm Management (CRM) and Device clinic referral form | 64 KB | |
| Colposcopy referral form – King’s College Hospital | 230 KB | |
| Complications of Excess Weight (CEW) Clinic referral form | 41 KB | |
| Dental – Guidance Notes for Paediatric Referrals | 79 KB | |
| Dental – South East London Oral Surgery Single Point of Access Referral Guide | 412 KB | |
| Dental Referral Form – Oral and Maxillofacial Surgery | 71 KB | |
| Dental Referral Form – South East London Oral Medicine | ||
| Dental Referral Form – South East London Oral Surgery | ||
| Dental Referral Form – South East London Paediatric Dentistry | 87 KB | |
| Dental Referral Form – South East London Restorative Dentistry | ||
| Dental Referral Form – Special Care Dentistry | 118 KB | |
| Diabetes Psychiatry and Psychology Service referral form | 642 KB | |
| Diagnostic Community Spirometry referral form | 1 MB | |
| Dietetic-led IBS clinic referral form | 78 KB | |
| Early pregnancy unit (EPU) referral form – Princess Royal University Hospital (PRUH) | 167 KB | |
| Echocardiography- Open Access form | 895 KB | |
| EEG referral form | 546 KB | |
| Electromyography and Nerve Conduction referral form | 866 KB | |
| Emergency Neurology Referral Form | 72 KB | |
| Frank Cooksey Rehabilitation Unit (FCRU) Service Specification and Admissions Guide | 69 KB | |
| Guidance notes for Special Care Dentistry Referrals | 364 KB | |
| Hand Therapy Referral Form | 53 KB | |
| HCC MDM referral form | 26 KB | |
| Headache referral form | 479 KB | |
| HIV GP referral form | 60 KB | |
| HPB MDM referral form | 88 KB | |
| Integrated Respiratory Team referral form | 145 KB | |
| Inter Healthcare Patient Transfer Form: Infection Prevention & Control Patient Risk Assessment | 208 KB | |
| Kidney disease management guidelines and referral checklist | 121 KB | |
| Kidney disease management guidelines and referral checklist – PRUH | 98 KB | |
| King’s College Hospital antenatal self-referral form | 102 KB | |
| King’s Older Persons’ Assessment Unit – Single referral form | 51 KB | |
| King’s Older Persons’ Assessment Unit infusion-transfusion referral form | 39 KB | |
| Lambeth and Southwark early arthritis referral form | 451 KB | |
| Lambeth and Southwark TIA referral form | 116 KB | |
| MCATS and MSK referral form – Lambeth | 77 KB | |
| MCATS referral form – Southwark | 93 KB | |
| Metastatic Cord Compression (MSCC) referral form – Neuro | 60 KB | |
| Musculoskeletal (MSK) physiotherapy referral form | 36 KB | |
| Neonatal conjugated jaundice referral form | 35 KB | |
| Neonatal conjugated jaundice referral pathway | 104 KB | |
| Nephrology and CKD services referral form | 217 KB | |
| NET MDM referral form | 23 KB | |
| Neuro-oncology referral form | 84 KB | |
| Neurosurgery Spinal Fracture Outpatient Request Form | 82 KB | |
| Neurosurgery Spinal MDT referral form | 69 KB | |
| Neurovascular Surgery MDT Referral form | 125 KB | |
| Nuclear Medicine Referral Form | 364 KB | |
| One-Stop General Gynaecology Clinic referral form – KCH | 43 KB | |
| Ontario Ward Service Specification and Admission Guide | 288 KB | |
| Ophthalmology Rapid Eye Service referral form | 650 KB | |
| Paediatric HPBOnc referral form | 112 KB | |
| Paediatric Liver referral form | 701 KB | |
| Pan-London All Age Specialist Palliative Care Referral Form | 864 KB | |
| PET-CT referral form | 250 KB | |
| Princess Royal University Hospital (PRUH) antenatal self-referral form | 119 KB | |
| Radiology Request Form GP | 28 KB | |
| Radiology Request Form SLaM | 28 KB | |
| Rapid Access Chest Pain Clinic Referral Form | 100 KB | |
| Respiratory Physiotherapy referral form | 30 KB | |
| Restorative Dentistry referrals acceptance criteria | 248 KB | |
| SEL Post-COVID Syndrome Referral Form | 37 KB | |
| Sexual Health Intervention and Prevention (SHIP) external referral form | 52 KB | |
| Sexual health service – referral form for GPs | 58 KB | |
| Skull Base Surgery referral form – King’s College Hospital | 81 KB | |
| Stroke and TIA referral form – PRUH | 280 KB | |
| Termination of Pregnancy referral form | 44 KB | |
| Tongue-tie Service referral form | 134 KB | |
| Virtual Fracture Clinic Referral Form | 108 KB |