The team on duty are available between 1030 - 2300 every day

Submit an online referral below

If you want t discuss your referral please contact us on

0300 303 4147

Online Referral Form

Make an online referral - NOT for Time Critical or Time Sensitive requests.

Date & Time information
Please help us to improve by entering the current time
(Form defaults to 12:00 - please provide a time below) If you are unsure of a date please leave a comment at the end and someone will contact you
Please note this is for pre planned transfers and not requests for today, on the day transfers will be confirmed between 1030 - 2300
Referring information
From what Hospital are we collecting the patient?
Who are we calling to discuss the referral? - **We will need patient clinical details to do our risk assessment and confirm the referral**
Please provide an email address so we can get back to you if needed
What Department/Ward/Unit are we collecting from?
Please include full external number and any extension required
Receiving information
What Hospital are we transferring to?
We need this in case of multiple requests from the same Hospital.
What Department/Ward/Unit are we transferring to?
clinical information (not essential but will assist with booking process)
Small dose of vasopressor or inotrope is acceptable
(mmHg)
Further detail and submit
Please do not include any patient identifiable information on this form, a member of the team will make contact to confirm the details needed. **We will need patient clinical details when we call you in order to do our risk assessment and confirm the referral**
All referrals are processed by the team on duty and transferred to secure NHS systems. No data is stored on this site or its servers.