ERS Referral Forms

Communications Team

These forms should be used by GPs when making a referral via the Electronic Referral System.

File Action
ERS Referral Form – Brain Download 
ERS Referral Form – Breast Download 
ERS Referral Form – Children Download 
ERS Referral Form – Colorectal Download 
ERS Referral Form – Community Cardiology Tape / Echo Download 
ERS Referral Form – Couples Subfertility Referral and Criteria Download 
ERS Referral Form – CT Request Form Download 
ERS Referral Form – CTS / Ulna Neuropathy Download 
ERS Referral Form – eTIA Download 
ERS Referral Form – Gynae Download 
ERS Referral Form – Head and Neck Download 
ERS Referral Form – 2ww Hepatobiliary Download 
ERS Referral Form – Humber Post COVID-19 Long Syndrome referral with MDT outcome Download 
ERS Referral Form – Humber Post COVID-19 Long Syndrome referral without MDT outcome Download 
ERS Referral Form – Lung Download 
ERS Referral Form – Malignancy of Unknown Origin (MUO) Download 
ERS Referral Form – Routine Skin Download 
ERS Referral Form – New Suspected 2ww Skin Cancer Download 
ERS Referral Form – Orthotics Download 
ERS Referral Form – Patient information 2ww Referral Download 
ERS Referral Form – PMB Ultrasound Request Download 
ERS Referral Form – RACPC (Rapid Access Chest Pain) Download 
ERS Referral Form – Radiology Plain Film Fluoroscopy Request Download 
ERS Referral Form – Radiology MRI Request Download 
ERS Referral Form – Radiology Rapid Diagnostic Service Download 
ERS Referral Form – Radiology Rapid Diagnostic Service – History Questions Download 
ERS Referral Form – Radiology Spinal MRI Request Download 
ERS Referral Form – Skin Cancer Download 
ERS Referral Form – T4 Bariatric Surgery Download 
ERS Referral Form – Transient Ischemic Attack (TIA) Download 
ERS Referral Form – Ultrasound Request Form Download 
ERS Referral Form – Upper GI (2ww) Download 
ERS Referral Form – Urology Download 

Page Created: 5th January 2018
Last Updated: 20th July 2021