Admin: Repeat Referral Request
It is important you endeavour to attend all healthcare appointments. Unattended appointments places increased pressure on services. Where possible please inform the relevant team that you are unable to attend an appointment so a new one can be scheduled.
Please complete the form below if you have missed an appointment OR a previous appointment has been cancelled and the hospital team has asked for the GP to complete a repeat referral.
Please do not write any symptom queries on this form. Any symptom queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception
01926 316711. We will start to process your form by the next working day but it will take up to
5 working days to complete. Please DO NOT call before
5 working days as you will not receive a status update from reception or the administrative team.
If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged
16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.
Admin: Repeat Referral Request
Privacy Protection
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Learn more about our Privacy Policy and
Terms of Use.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.