Direct Endoscopy Referral

We accept direct endoscopy referrals for low-risk patients directly from GPs. Low-risk patients are those who do not have any significant co-morbidities that place them at increased risk of anaesthetic or procedural complications. If your patient does not meet these criteria, or you are unsure, we recommend that you refer your patient for a pre-procedure consultation where these risks can be better assessed.

"*" indicates required fields

Referral to:

GP details

Patient Details

Procedure

Required procedure*
Does your patient have any significant co-morbidities that may increase their anaesthetic or procedural risk?*
These include significant cardiac, respiratory, renal, metabolic (complex diabetes, BMI >38), or neurologic conditions, or significant cognitive, language, or mobility limitations. If you are unsure, we recommend that you select “Yes” and we will arrange a pre-procedure consultation.
Is your patient on anti-coagulation or anti-platelet therapy (excluding Aspirin)*
Does your patient take any medications for diabetes?*
Is your patient aware of this referral?*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.