GP Referral Form

Referring a patient to North West Independent Hospital

Referring a patient to North West Independent Hospital has never been so easy, simply follow this step by step guide and submit the request.

Fill in the required fields (marked with *), Please include H&C Number for all patients based in Northern Ireland/United Kingdom (H&C number is not required for patients based in the Republic of Ireland).

Include an outline of the patient’s problems and any relevant past medical history as this will allow us to pair your patient with the best possible consultant.

GP Details- Including the referring GP details will allows us to contact the GP via telephone or letter to inform you of our findings/examination results.

After submitting the request form our appointments team will contact the patient directly to arrange an appointment at a time and date which is convenient to them.

(If patient is from NI)

(e.g. ENT, Cardiology etc).

If you are any issues filling this out you can send us a referral by post to:

North West Independent Hospital
Church hill house,
Main St. Ballykelly
BT49 9HS

Fax: 028 777 66880 (Fax from ROI 048 777 66880).

We look forward to welcoming your patient at North West Independent Hospital.

Book your medical consultation now