Referral forms

Referral forms are available to download in EDWT and word format for services at services at The Royal London, Mile End and St Bartholomew’s hospitals.

Two week cancer referral forms are available separately here.

Paper switch off for GP referrals

We have agreed our trust plans for implementing paper switch off. Please visit the urgent GP information section of our website for further information.

Referral forms

Referral form in Word Referral form in EWDT
Rapid Access Chest Pain Clinic Referral Form Newham Hospital ewdt not available
Rapid Access Chest Pain Clinic Referral Form Whipps Cross Hospital  
Rapid Access Chest Pain Clinic Referral Form St Barts / Royal London Hospital  
Rapid Access Heart Rhythm clinic referral form.doc [doc] 46KB ewdt not available
Cardio-respiratory rehab referral form.doc [doc] 124KB ewdt not available
Dental & OMFS  

Oral and Maxillofacial Surgery Referral Form

Orthodontic Referral Form  
Oral Medicine Referral Form  
Paediatric Dentistry Referral Form


Restorative Dentistry Referral Form  
Dermatology Inpatient Referral Form - Whipps Cross Hospital  
Digestive disease  
Gastroscopy referral form.doc [doc] 117KB  
Gastrocopy referral form (WHIPPS CROSS ONLY)  
Flexible sigmoidoscopy referral form.doc [doc] 107KB  
Hepatobiliary and Pancreas Surgery  

HPB severe acute pancreatitis referral form [pdf] 373KB

Hepatobiliary and Pancreas Cancer referral form.pdf [pdf] 455KB  
Imaging request form.doc [doc] 148KB ewdt not available
Dexa scan referral form.doc [doc] 100KB ewdt not available
Maternity endocrine referral form.doc [doc] 57KB  
Maternity ultrasound referral form.doc [doc] 49KB  
Antenatal care referral form.doc [doc] 90KB  
Musculoskeletal referral form.rtf [rtf] 2MB ewdt not available
Neurophysiology request form RLH.doc [doc] 37KB  
Tower Hamlets Community Health Service  

Tower Hamlets Referral_Form [docx] 53KB

Tower Hamlets Specialist Children Services Referral Form Oct 2018

Barts health Specialist Children's Services Guidance for Referrers October 2018

Palliative care  
PallE8 Referral form.pdf[pdf] 392KB  

Cancer single point of referral checklist[docx] 2MB

Cancer consultant upgrade request form (Barts Health staff referrals only)[docx] 73KB