We do require a form to book this appointment some examinations need instructions or consent forms – Options for booking this appointment: GP to send in via internal post /Choose & Book/Email Patient or GP to fax to 01883 713779 Patient to Post to Oxted Health Centre or email Patient to call in to clinic clerks between 8.30am 12.30pm or 2pm 4.30pm – – PLEASE MAKE SURE WE HAVE THE CORRECT CURRENT ADDRESS AND CONTACT NUMBERS ON THE FORM. SURNAME GP: FORENAMES Practice: NHS Number: CCG: ADDRESS Date of Date form sent: Home Telephone No: Urgent / Routine NHS Mobile Contact No: Centre Preferred: We will text you to remind you of your appointment Oxted Redhill Either Work No: Email address: Date Received: Tick if we may message for you on any of your contact details Type of Examination: Abdomen / Renal Tract / Gynae and/or Bladder/ Thyroid / Testes / Musculoskeletal/Carotid Please circle Other: Clinical Problem; Appointment Date Aim of examination: Please let us know if there are any physical/communication difficulties, wheelchair user or if an interpreter is required
We do require a form to book this appointment – some examinations need instructions or consent forms Options for booking this appointment: GP to send in via internal post /Choose & Book/Email Patient or GP to fax to 01883 713779 Patient to Post to Oxted Health Centre or email Patient to call in to clinic clerks between 8.30am – 12.30pm or 2pm – 4.30pm PLEASE MAKE SURE WE HAVE THE CORRECT CURRENT ADDRESS AND CONTACT NUMBERS ON THE FORM. SURNAME GP: FORENAMES Practice: NHS Number: CCG: ADDRESS Date of Date form sent: Home Telephone No: Urgent / Routine NHS Mobile Contact No: Centre Preferred: We will text you to remind you of your appointment Oxted Redhill Either Work No: Email address: Date Received: Tick if we may message for you on any of your contact details Type of Examination: Abdomen / Renal Tract / Gynae and/or Bladder/ Thyroid / Testes / Musculoskeletal/Carotid Please circle Other: Clinical Problem; Appointment Date Aim of examination: Please let us know if there are any physical/communication difficulties, wheelchair user or if an interpreter is required
Ultrasound_Request_Form.docx