GP REFERRAL
SELF REFERRAL
GP Name
GP Email
Patient Name
Patient Email
Patient Age
Contact Details
Referral & Medical history
Investigations
Pathology X-ray CT/MRI
Notes
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Other than for cosmetic surgery / procedures all referrals must come through your General Practitioner. It is always advisable that you contact your GP in the first instance if you are seeking cosmetic surgery. All referrals will be answered within 24 hours with an appointment where possible.
GP Name
Name
Email
Phone
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