Lymphoedema referral

To make your lymphoedema referral, please complete all the applicable fields in the form below.

Once your referral is in our system, we will contact the patient’s GP to approve the appointment and any transport requirements. Patients will be seen according to the degree of urgency.

Lymphoedema referral form

  • Drop files here or
    Accepted file types: pdf, doc.
    You can upload your EMIS files here or email as per the details below.