Referral Form

These forms are only for tertiary referrals from other hospitals. We will not accept referrals from GPs using the online referral form below.

If you are a GP referring to the RNOH please use the NHS e-referral system, e-RS.

Required

Referrer’s details


Referrals will only be accepted from consultants in oncology, neurosurgery or orthopaedics


Required
Required
Required
Required
Required

Patient details

Required
Required
Required
Required
Required

Neurology

Required

Steroids given

Required

Histopathology Diagnosis

Required

Chemotherapy/Systemic therapy

Required

Radiotherapy:

Required

Bloods results

Available imaging

Please tick box


All images have to be uploaded to IEP before referral can be accepted


Consent to record telephone conversation with RNOH consultant


Please note that any clinical telephone conversation between referrer and consultant will be recorded and a transcription of that conversation will be entered as part of the patient record.


Required