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Referral forms

Various King’s specialties require you to complete specific referral forms to accompany the referral documentation that you email to us. We have collated the latest versions of these forms here, for your convenience. They can also be downloaded from the referral information section of the relevant department in the services directory.

For more details and advice, read our guidelines on referring patients to King’s.

TitleFile SizeLink
12 lead ECG referral form39 KB
24HR BP monitor referral form36 KB
24HR ECG monitor referral form38 KB
Advanced Chronic Liver Disease MDM referral form268 KB
Antenatal GP and medical referral form259 KB
Cardiac diagnostics – Event Recorder referral form38 KB
Cardiac Rhythm Management (CRM) and Device clinic referral form64 KB
Colposcopy referral form – King’s College Hospital230 KB
Complications of Excess Weight (CEW) Clinic referral form41 KB
Dental – Guidance Notes for Paediatric Referrals79 KB
Dental – South East London Oral Surgery Single Point of Access Referral Guide412 KB
Dental Referral Form – Oral and Maxillofacial Surgery71 KB
Dental Referral Form – South East London Oral Medicine
Dental Referral Form – South East London Oral Surgery
Dental Referral Form – South East London Paediatric Dentistry
Dental Referral Form – South East London Restorative Dentistry
Dental Referral Form – Special Care Dentistry118 KB
Diabetes Psychiatry and Psychology Service referral form642 KB
Diagnostic Community Spirometry referral form1 MB
Dietetic-led IBS clinic referral form78 KB
Early pregnancy unit (EPU) referral form – Princess Royal University Hospital (PRUH)70 KB
Echocardiography- Open Access form895 KB
EEG referral form546 KB
Electromyography and Nerve Conduction referral form866 KB
Emergency Neurology Referral Form72 KB
Exercise tolerance test (ETT) referral form38 KB
Frank Cooksey Rehabilitation Unit (FCRU) Service Specification and Admissions Guide69 KB
Guidance notes for Special Care Dentistry Referrals364 KB
Hand Therapy Referral Form53 KB
HCC MDM referral form26 KB
Headache referral form479 KB
HIV GP referral form60 KB
HPB MDM referral form88 KB
Integrated Respiratory Team referral form145 KB
Inter Healthcare Patient Transfer Form: Infection Prevention & Control Patient Risk Assessment208 KB
Kidney disease management guidelines and referral checklist121 KB
Kidney disease management guidelines and referral checklist – PRUH98 KB
King’s College Hospital antenatal self-referral form102 KB
King’s Older Persons’ Assessment Unit – Single referral form51 KB
King’s Older Persons’ Assessment Unit infusion-transfusion referral form39 KB
Lambeth and Southwark early arthritis referral form451 KB
Lambeth and Southwark TIA referral form116 KB
MCATS and MSK referral form – Lambeth77 KB
MCATS referral form – Southwark93 KB
Metastatic Cord Compression (MSCC) referral form – Neuro60 KB
Musculoskeletal (MSK) physiotherapy referral form36 KB
Neonatal conjugated jaundice referral form35 KB
Neonatal conjugated jaundice referral pathway104 KB
Nephrology and CKD services referral form217 KB
NET MDM referral form23 KB
Neuro-oncology referral form84 KB
Neurosurgery Spinal Fracture Outpatient Request Form82 KB
Neurosurgery Spinal MDT referral form69 KB
Neurovascular Surgery MDT Referral form46 KB
Nuclear Medicine Referral Form364 KB
One-Stop General Gynaecology Clinic referral form – KCH43 KB
Ontario Ward Service Specification and Admission Guide288 KB
Ophthalmology Rapid Eye Service referral form650 KB
Paediatric HPBOnc referral form112 KB
Paediatric Liver referral form701 KB
Pan-London All Age Specialist Palliative Care Referral Form864 KB
PET-CT referral form250 KB
Princess Royal University Hospital (PRUH) antenatal self-referral form119 KB
Radiology Request Form GP28 KB
Radiology Request Form SLaM28 KB
Rapid Access Chest Pain Clinic Referral Form100 KB
Respiratory Physiotherapy referral form30 KB
Restorative Dentistry referrals acceptance criteria248 KB
SEL Post-COVID Syndrome Referral Form37 KB
Sexual Health Intervention and Prevention (SHIP) external referral form52 KB
Sexual health service – referral form for GPs58 KB
Skull Base Surgery referral form – King’s College Hospital81 KB
Stroke and TIA referral form – PRUH280 KB
Termination of Pregnancy referral form44 KB
Tongue-tie Service referral form134 KB
Virtual Fracture Clinic Referral Form108 KB