Medical Referral Letter Template UK

The Medical Referral Letter Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring editable and printable examples for your convenience.

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Online – Template

Sample

Medical Referral Letter Template UK

Editable – Printable

PDF – 1 PDF – 2

Medical Referral Letter Template UK

1. Patient Information



2. Referring Doctor Information


3. Referral Details

4. Reason for Referral

5. Relevant Medical History

7. Previous Referrals and Treatments

8. Additional Notes

9. Consent for Referral

10. Signatures and Date



PDF

WORD

Examples

Medical Referral Letter Template UK (1)
From:
[Doctor’s Name]
[Medical Practice Name]
[Practice Address]
[City, Postcode]
[Phone Number]
[Email Address]
To:
[Specialist’s Name]
[Specialist’s Practice Name]
[Specialist’s Address]
[City, Postcode]
Date:
[Date of Referral]
Patient Information:
[Patient’s Full Name]
[Patient’s Date of Birth]
[Patient’s NHS Number]
[Patient’s Address]
Re: Referral for [Reason for Referral]
Dear [Specialist’s Name],
I am referring my patient, [Patient’s Full Name], who has been under my care since [Date]. The patient presents with [describe the symptoms, concerns, and medical history relevant to the referral].
Clinical Findings:
On examination, findings include [detail any significant findings such as test results, vital signs, and relevant investigations].
Treatment Provided:
So far, I have administered [list any treatment, medications, or interventions undertaken]. The response to treatment has been [explain how the patient has responded to previous treatment].
Request for Consultation:
I believe the patient would benefit from your expertise in [specify the area of specialist treatment required]. Please assess the patient regarding [specific concerns or procedures].
Attachments:
Enclosed are copies of relevant medical records, test results, and imaging studies for your review.
Thank you for your assistance in this matter.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name]
[Position/Title]
Medical Referral Letter Template UK (2)
From:
[Doctor’s Name]
[Medical Practice Name]
[Practice Address]
[City, Postcode]
[Phone Number]
[Email Address]
To:
[Specialist’s Name]
[Specialist’s Practice Name]
[Specialist’s Address]
[City, Postcode]
Date:
[Date of Referral]
Patient Information:
[Patient’s Full Name]
[Patient’s Date of Birth]
[Patient’s NHS Number]
[Patient’s Address]
Re: Assessment for [Reason for Referral]
Dear [Specialist’s Name],
I am writing to refer my patient, [Patient’s Full Name], for further evaluation and management of [detailed reason for referral]. The patient has experienced [describe symptoms and duration].
History of Present Illness:
The patient reports [include a detailed description of the patient’s symptoms, associated factors, and previous treatments].
Physical Examination:
Upon examination, notable findings include [list significant findings].
Previous Investigations:
I have conducted the following tests: [list tests performed and results].
Reason for Referral:
I kindly request your assessment on [specific issues, procedures, or treatments needed].
Attachments:
Included are the patient’s medical records and test results for your review.
Thank you for your attention to this matter.
Yours sincerely,
[Doctor’s Signature]
[Doctor’s Name]
[Position/Title]

Printable

PDF – 1 PDF – 2

Medical Referral Letter Template UK