Referral Forms

To refer a patient simply complete one of our referral forms and post, email or fax the form to us, or alternatively use Choose & Book

Our referral forms are available in various versions that are compatible with your GP surgery I.T system. Your practice and referrer details will populate automatically, together with patient contact detail, demographics and patient history.

Please note that our email address for referrals is inl.inhealthreferrals@nhs.net.   

Select which referral form version you would like from the options below:  If you would like help in integrating a referral form with your GP system please see the help documents below. (In the Word section for EMIS WEB or PDF section for help with Vision and EMIS PCS).   Please note that InHealth were sent these help documents from a friendly CCG source - we have no access to GP systems and so do not know if the information in them is accurate.  If you are unsure, please speak to whomever deals with IT in your practice.

We have been contacted by some practice managers who have struggled with the EMIS WEB referral forms loaded here.   We have been told that the EMIS LV version (also available here) will  work with EMIS WEB .   Please do let us know if you have a different experience!

To refer a patient, simply complete one of our referral forms and send it to us or book the patient appointment using Choose & Book.

EMIS LV

File Barking & Dagenham, Havering & Redbridge CCG MRI Ref Form Feb 2016
File Barking & Dagenham, Havering & Redbridge CCG Endoscopy Referral Form
File Barking & Dagenham, Havering and Redbridge EMIS LV Audiology Referral form
File Brent - Hammersmith & Fulham - Kensington & Chelsea - Westminster Audiology Referral form Mar 2016
File Brent - Hammersmith & Fulham - Kensington & Chelsea - Westminster Endoscopy referral form Mar 2016
File Brent- Hammersmith & Fulham - Kensington & Chelsea - Westminster Phys Med referral form Mar 2016
File Brent - Hammersmith & Fulham - Kensington & Chelsea - Westminster MRI referral form Mar 2016
File Brent - Hammersmith & Fulham - Kensington & Chelsea - Westminster Ultrasound referral form Mar 2016
File Enfield CCG MRI Referral form
File Enfield CCG Audiology Referral form
File Hillingdon CCG MRI Referral form EMIS Mar 2016
File Merton CCG Audiology Referral form
File Merton CCG DXA referral form
File Merton CCG Endoscopy referral form
File Merton CCG MRI referral form
File Merton CCG Phys Med including Echo referral form
File Merton CCG Ultrasound referral form
File Merton CCG X ray referral form
File Richmond CCG audiology referral form July 2015
File Richmond CCG DEXA referral form July 2015
File Richmond CCG Endoscopy referral form July 2015
File Richmond CCG MRI Referral form July 2015
File Richmond CCG Phys Med including Echo referral form July 2015
File Richmond CCG Ultrasound referral form July 2015
File Richmond CCG X-ray referral form July 2015
File Waltham Forest CCG MRI Referral form Feb 2016
File Upper and lower Endoscopy referral form
File Bexley CCG Audiology referral form
File Bexley CCG DXA referral form
File Bexley CCG Endoscopy referral form
File Bexley CCG MRI Referral form
File Bexley CCG Ulrasound referral form
File Bexley CCG X ray referral form
File Wandsworth CCG Audiology referral form
File Wandsworth CCG DXA referral form
File Wandsworth CCG MRI Referral form
File Wandsworth CCG Endoscopy referral form July 2016
File Wandsworth CCG Ultrasound referral form July 2016
File Wandsworth CCG X Ray referral form July 2016
File Wandsworth CCG Phys Med referral form July 2016

EMIS PCS

Microsoft Office document icon MRI Referral form
Microsoft Office document icon Audiology referral form
Microsoft Office document icon DXA Referral form
Microsoft Office document icon Endoscopy referral form
Microsoft Office document icon Physiological measurement (including Echo)
Microsoft Office document icon Ultrasound referral form
Microsoft Office document icon X-ray referral form
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge EMIS MRI Referral form
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge EMIS PCS Endoscopy Referral form
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge EMIS PCS Audiology Referral form
Microsoft Office document icon Richmond CCG Audiology referral form July 2015
Microsoft Office document icon Richmond CCG DXA referral form July 2015
Microsoft Office document icon Richmond CCG Endoscopy referral form July 2015
Microsoft Office document icon Richmond CCG MRI Referral form July 2015
Microsoft Office document icon Richmond CCG Phys Med including Echo referral form July 2015
Microsoft Office document icon Richmond CCG Ultrasound referal form July 2015
Microsoft Office document icon Richmond CCG X-ray referral form July 2015
Microsoft Office document icon Waltham Forest Echocardiography Referral form Feb 2016
Microsoft Office document icon Waltham Forest MRI Referral form Feb 2016
Microsoft Office document icon Upper and Lower Gi Endoscopy Referral form

EMIS WEB

Binary Data X ray April 2014
Binary Data MRI April 2014
Binary Data Audiology 2014
Binary Data Lower GI Endoscopy 2014
Binary Data DXA 2014
Binary Data Ultrasound 2014
Binary Data Physiological Measurement 2014

PDF

PDF icon Audiology referral form October 2015
PDF icon EMIS PCS help
PDF icon Vision help
PDF icon MRI Referral form
PDF icon Open MRI referral form and funding authorisation - Croydon September 2014
PDF icon Physiological Measurement (including Echo)
PDF icon X ray referral form
PDF icon Ultrasound referral form
PDF icon Lower GI Endoscopy referral form
PDF icon DXA Referral form
PDF icon Barking & Dagenham, Havering & Redbridge CCG Endoscopy Referral form Oct 2014
PDF icon Barking & Dagenham, Havering & Redbridge CCG Audiology Referral form Oct 2014
PDF icon Barking & Dagenham, Havering & Redbridge CCG Physiological Measurement Referral form Oct 2014
PDF icon Barking & Dagenham, Havering & Redbridge CCG MRI Referral form
PDF icon 0235 IH Endoscopy Flowchart
PDF icon 0237 IH Endoscopy GP Guide
PDF icon 0236 IH - Endoscopy FAQs Press

TPP SystmOne

Microsoft Office document icon Audiology referral form October 2015
Microsoft Office document icon MRI referral form April 2014
Microsoft Office document icon Physiological Measurement (including Echo) April 2014
Microsoft Office document icon Ultrasound referral form April 2014
Microsoft Office document icon Lower GI Endoscopy referral form April 2014
Microsoft Office document icon DXA Referral form April 2014
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge Audiology Referral form Mar 2016
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge Endoscopy referral form Mar 2016
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge MRI referral form Mar 2016
Microsoft Office document icon Hillingdon CCG MRI Referral Form SysOne Mar 2016
Microsoft Office document icon Upper and lower endoscopy referral form July 2015

VISION

Microsoft Office document icon DEXA referral form (unprotected)
Microsoft Office document icon Audiology Referral form October 2015
Microsoft Office document icon X-ray referral form (unprotected)
Microsoft Office document icon Endoscopy referral form (unprotected)
Microsoft Office document icon MRI referral form (unprotected)
Microsoft Office document icon Ultrasound referral form (unprotected)
Microsoft Office document icon Physiological measurement referral form (unprotected)
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge VISION MRI Referral form
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge VISION Endoscopy Referral form
Microsoft Office document icon Barking & Dagenham, Havering and Redbridge VISION Audiology Referral form
Microsoft Office document icon Hillingdon CCG MRI Referral Form VISION Mar 2016
Microsoft Office document icon Merton CCG Audiology referral form
Microsoft Office document icon Merton CCG DXA referral form
Microsoft Office document icon Merton CCG Endoscopy referral form
Microsoft Office document icon Merton CCG MRI referral form
Microsoft Office document icon Merton CCG Phys Med including Echo referral form
Microsoft Office document icon Merton CCG Ultrasound referral form
Microsoft Office document icon Merton CCG x-ray referral form
Microsoft Office document icon Richmond CCG DXA referral form
Microsoft Office document icon Richmond CCG endoscopy referral form
Microsoft Office document icon Richmond CCG MRI Referral form
Microsoft Office document icon Richmond CCG Phys Med (including Echo) referral form
Microsoft Office document icon Richmond CCG Ultrasound referral form
Microsoft Office document icon Richmond CCG X-ray referral form
Microsoft Office document icon Richmond CCG Audiology referral form
Microsoft Office document icon Waltham Forest Echocardiography Referral Form Feb 2016
Microsoft Office document icon Upper and lower endoscopy referral form
Microsoft Office document icon Bexley CCG Audiology referral form
Microsoft Office document icon Bexley CCG DXA referral form
Microsoft Office document icon Bexley CCG Endoscopy referral form
Microsoft Office document icon Bexley CCG MRI Referral form
Microsoft Office document icon Bexley CCG Ultrasound referral form
Microsoft Office document icon Bexley CCG X ray referral form
Microsoft Office document icon Wandsworth CCG Audiology referral form
Microsoft Office document icon Wandsworth CCG DXA Referral form
Microsoft Office document icon Wandsworth CCG Echo referral form
Microsoft Office document icon Wandsworth CCG Endo referral form
Microsoft Office document icon Wandsworth CCG MRI Referral form
Microsoft Office document icon Wandsworth CCG Ultrasound referral form
Microsoft Office document icon Wandsworth CCG x-ray referral form

WORD

Microsoft Office document icon EMIS Web Help document
Microsoft Office document icon 2_lower_gi_endoscopy_referral_form_nov_2015.doc
Microsoft Office document icon 2_ultrasound_referral_form_nov_2015_word.doc
Microsoft Office document icon mri_referral_form_october_2015.doc
File Open MRI referral form and funding authorisation - Croydon September 2014
File X-ray referral form
Microsoft Office document icon Audiology Referral form October 2015
Microsoft Office document icon 2_dxa_referral_form_nov_2015.doc
Microsoft Office document icon physiological_measurement_referral_form_nov_2015.doc
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge Physiological Measurement Referral Form Word version
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge Audiology Referral form Jan 2015
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge MRI Referral form
File Barking & Dagenham, Havering & Redbridge Lower Endoscopy Only Referral form
Microsoft Office document icon Barking & Dagenham, Havering & Redbridge Upper and Lower Endoscopy Referral form
Patients
0333 202 0297
Fax: 0333 200 1163
INL.InHealthreferrals@nhs.net
Referral information
Patients
0333 202 0300
Referring Clinicians / Reporters
0333 202 0297
ihl.inhealthreferrals@nhs.net
Referral information
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