Referral Forms & Checklists

***Referral Forms and Checklists – Templates Now Online!***

Templates for your practice systems, including EMIS, Synergy, are now available online for dermatology, headache, respiratory and gynaecology.  New forms will be added as soon as they become available.  These can be downloaded from the SE London intranet site:

***NEW! Community Services Referral Forms***

Forms are now available for local community services, including Diabetes, Respiratory, Headache and Eczema Education.   Templates are currently being developed for practice systems, and will be posted as soon as they are available.

Eczema Education

Eczema Education Programme Referral form v2


Lambeth community headache service referral form
Headache Service Formulary

respiratory guidance and referral form

Criteria for patients suitablefor referral to the community diabetes clinic
Criteria for patients who should be managed in a specialist hospital diabetes clinic
Diabetes – Information for Patients
Lambeth diabetes referral form

Other Referral Checklists
These were developed several years ago, in a previous time of demand management. Thanks to those who worked on them.
As we have reviewed pathways, there seems to be consensus that these checklists are useful.  These checklists are currently being refreshed and formatted for use on practice IT systems.

Referral Checklists


Discharging ears
Nasal obstruction
Dizziness Vertigo

Knee replacement
Hip replacement
Anterior knee pain
Lumbar spinal surgery
Cervical spinal surgery


Other referral advice
NICE Referral Advice Recommendations database.
Patient Decision Aids
For: Advanced Kidney Disease, BPH, Cataracts, Prostate cancer, PSA testing, CVS and Amnio, Breast cancer, Hip arthritis, Knee arthritis.
Make more appropriate referrals with an informed patient.

Please also consider the use of Advice & Guidance via Choose and Book, which is available for all specialities in the directory at King’s and for Gynaecology and Urology at GSTT.

Directory of Services
Please note this is currently being updated.
Demand Management Toolkit

For questions about referral forms and checklists, please contact Alicia Reeves,

3 thoughts on “Referral Forms & Checklists

  1. Pingback: 2010 in review « Lambeth PBC Collaborative

  2. Pingback: 2010 in review « Lambeth PBC Collaborative

  3. Pingback: New Referral Forms and Checklists | Lambeth Clinical Commissioning Collaborative

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