Please fill in the form below.
Islington referrals: Please use the Accept Consortium referral form [click here].
Haringey referrals: We have now met our contracted quota for this quarter and so the waiting list for people with a Haringey GP is closed. We will begin accepting Haringey referrals again on October 1st, 2017. In the meantime, you can access a list of other services that may be of assistance here.
Enfield referrals: We have now met our contracted quota for this financial year (April-March) and so the waiting list for people with an Enfield GP is closed. You can access a list of other services that may be of assistance here.
Download a referral form
If you prefer, you can download one of the following forms:
Right click to download and save the Word doc, then email completed forms to firstname.lastname@example.org or via secure email to email@example.com. We also accept letters and faxes.