Refer your patient

to Harrogate Harlow Private Healthcare Service

Referring your private patients or requesting a private appointment for diagnostic tests or treatment is fast and straightforward.

Refer a patient by…

INFORMATION REQUIRED FOR A REFERRAL

In order to proceed with the referral we will ask you for some more information about your patient’s medical history. This may include some or all of the following:

  • Patient name
  • Date of birth
  • Gender
  • Home address and (if applicable) temporary UK address
  • Telephone number(s)
  • Email address
  • Funding details (including insurer’s name if funding through medical insurance)
  • Patient GP details (UK only)
  • Diagnosis
  • Current treatment and medications

REFERRAL FORM

Referring clinician’s details

Patient details

Referral details

Funding

4 + 3 = ?

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