Kingsbridge Private Hospital

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Belfast: 028 9066 7878

North West: 028 7776 3090

Cross Border Health: 048 9068 8858

Have a query or wish to book an appointment? Text BOOK to 66777 & We'll Call You Back

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Refer a Patient

The referral forms below are for healthcare professionals only. If you are a patient and wish to send a referral from your clinician, please Contact Us

MRI Referral Form

X-Ray Referral Form

BP Referral Form

Echo Referral Form

ECG Referral Form

Ultrasound Referral

Treadmill Referral Form

CT Referral Form

24hr/14 Day Loop

CT Colonography Referral

Please fill in the form below to refer your patient for treatments other than those above.

Referring Clinician Details

Doctor Name * Practice Address * Contact Number * Email *

Patient Details

Patient Name * Patient Address * Date of Birth *

Contact Number * Patient Email *

Referral Details

Specialiality * Consultant * Reason for referral * Funding *

Insured

Self-funding

Funding referral *

If the named consultant is unable to see your patient within our target of 7 working days, would you be happy for us to refer to another appropriate consultant?

Yes

No

Captcha *

* Required

We deal with all consultants and all specialties – we aim to place your patient with an appropriate specialist within 7 working days. Thank you for your referral.

Help & Support

Kingsbridge Help & Support

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

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