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

Required
Required
Required
Required
Required

Patient details

Required
Required
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Required
Required

Level of injury

area-of-infection.jpg

Please tick relevant box

Other associated injury

Neurology

Required

Full ASIA Score

Required

Please note, we only accept level E.

Steroids given

Required

Available imaging

NOTE: We won’t accept a referral without an MRI of the whole spine.

Available imaging. Please tick box

Reason for referral

Required

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