Refer Yourself for Emergency Scope at Kingsbridge Hospital

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7 Day Endoscopy Self-Referral

Referrers are required to complete all sections accurately. Incomplete forms will not be accepted.

This form requires submission of a letter of referral from either a GP or consultant to book an endoscopy procedure. If you do not have a referral letter you can book an appointment with a Kingsbridge GP or consultant by using the link below.

Online Appointment Booking

Our procedures team will be in contact within one working day of your appointment booking.

Funding Type

Procedure Funding Method *

Self-funding

Insurance funded

Patient Details

PatientName * Date of Birth * Address * Email Address * Contact Number * NHS H&C Number (if known) Gender at birth

Male

Female

Referral Details

Do you have a copy of your referral letter? *

Yes

No

Please upload a copy of your GP or consultant referral letter * Captcha *

* Required

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Kingsbridge Help & Support

For enquires on post operative support, cancellations, test results and payment

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