Referrals – Evelyn Medical Centre

01433 621557 ddicb.admin.emc@nhs.net

Referrals
What would you like to do?

I would like to request a referralI would like to track a referral

Did you book the referral through NHS e-Referral?

YesNo

Was your referral to a local hospital?

YesNo

Referral Request
Name*

First Name Last Name
Date of birth*

MonthDay Year
Date
Tel:*
Email*
example@example.com
Named GP (if know)
Who would you like a referral to?
Why do you need this referral?

NHS e-Referral Tracking

If your doctor has referred you to a specialist for further care you will be asked to book your appointment using the ‘NHS e-Referral’ system.

You will receive a letter from us within 2 weeks giving details of how to book your appointment and any passwords you may need.

To track your e-Referral you will need the following details to log into the e-Referral website:
- Your date of birth
- Reference number – this will be on the first page of your letter
- Password – this will be on the second page of your letter
Further information

Choosing from a list of hospitals or clinics
NHS e-Referral Service
Book or change your Specialist Appointment online now

Contact a local hospital

8.9 miles away

Claremont Private Hospital
401 Sandygate Road, Sheffield, Sheffield, South Yorkshire, S10 5UB
0114 263 0330

9.3 miles away

Cavendish Hospital
Manchester Road, Buxton, Derbyshire, SK17 6TE
01298 212800

9.5 miles away

Newholme Hospital
(Head Office), Baslow Road, Bakewell, Derbyshire, DE45 1AD
01629 812525

Track a referral
Name*

First Name Last Name
Date of birth*

DayMonth Year
Date
Tel:*
Email*
example@example.com
Who were you waiting to be referred to?
Should be Empty: