ERS Referral Forms

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 – CTS / Ulna Neuropathy Download 
ERS Referral Form – Gynae Download 
ERS Referral Form – Head and Neck Download 
ERS Referral Form – Lung Download 
ERS Referral Form – Malignancy of Unknown Origin (MUO) Download 
ERS Referral Form – PMB Ultrasound Request Download 
ERS Referral Form – Orthotics Download 
ERS Referral Form – RACPC (Rapid Access Chest Pain) Download 
ERS Referral Form – Sarcoma Download 
ERS Referral Form – Skin Download 
ERS Referral Form – T4 Bariatric Surgery Download 
ERS Referral Form – Transient Ischemic Attack (TIA) Download 
ERS Referral Form – Upper GI Download 
ERS Referral Form – Urology Download 
Page Created: 5th January 2018
Last Updated: 8th April 2019