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, Max. file size: 8 MB, Max. files: 20.
      You can upload your EMIS files here or email as per the details below.
    • If you want to provide photographs of a wound or limb, email them securely to giving the name of the patient and date of birth.