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Healthcare professionals referral form

If the patient is undergoing cancer treatment, either currently or in the near future, you can refer them to prehabilitation. Alternatively, if your patient has recently finished their cancer treatment, you can refer them to rehabilitation.

Please, fill in the referral form as thoroughly as possible. This will help us to speed up the process and get in touch with the patient as soon as possible.

If you use InfoFlex, you can learn how to quickly make your referrals by using InfoFlex. Click here to see a guide.

Note that those fields showing an asterisk (*) are required.

About you (person making the referral)

About your patient (person being referred)

About the patient's GP

About the patient's cancer consultant

About the patient's Cancer Nurse Specialist (CNS)