Filename: BNSSG-T3-REFERRAL-FORM-EREFERRAL2632019.DOC
File type: DOC
File size: 97 KB
Description: Referral form for the Tier 3 Weight Management Service for BNSSG Patients.
Please
fill in all sections of this referral form along with any other
information you think is relevant to this patient’s
case (medication list, clinic letters etc).
Please could you ensure
that the relevant blood tests in section 2.b) have been completed and the results
(which must be within the last 3 months) are attached.
The
referral will not be accepted unless the referral form is complete and all of
the blood tests have been completed.