Referral forms

Cancer referral forms
Please find below the NICE GP cancer referral guidance and the North West London Cancer network referral forms for the following conditions (PDF, requires Adobe Acrobat Reader, free download):

You are encouraged to use these forms for suspected cancer patients. The forms also include telephone and fax numbers for the 2 Week Wait co-ordinators.

Optometrist direct referral to Western Eye Hospital
Optometrists can refer directly to Western Eye Hospital for both routine medical retina conditions and urgent wet AMD using our secure online or fax referral form. Optometrists are reminded that they are obliged to inform the patient’s GP about any referrals they make to acute trusts in accordance with GOS 2008 and the Optician’s Act 1989. Patients with wet AMD are seen within one week in our fast-track clinic, and routine referrals are usually seen within four to six weeks. For more information email macula@imperial.nhs.uk. If you have a query about a referral you have made, please contact our AMD coordinator on 020 3312 7724 or send as a message using our online enquiry form.
• Medical retina service - fax referral form for routine and urgent cases
• Medical retina service - online referral form for routine and urgent cases

Other referral information

Trusts referring to our services can find more information in our interprovider referrals section.