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