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Direct Access Endoscopy Referral

*All fields must be completed by referring Doctor

Download Printable Version


Patient Contact Details






GP/Referrer Details




Referral Information

Diagnostic Colonoscopy
Upper GI Endoscopy


Past Medical History


Current Medications
Is the patient diabetic?*



Departments & Services
Available services, consultants list, guides and contact details.

Consultants
Consultant profiles, areas of expertise, qualifications and experience.

GP Information
Fast & secure e-referral system in junction with Clan William and Health Link..

Patients & Visitors
Information about COVID 19, admissions, facilities, children as patients.