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One stop colorectal service referral form

Select Hospital Referral
Date of Referral

PATIENT DETAILS

Forename
Surname

GP DETAILS

Name
Practice Address
Tel No
Date of Birth
Gender
Fax No

Our service:

The principle aim of the clinic is to provide a one-stop service for the majority of patients. All patients will have an initial consultation with Mr varcada, when clinically indicated patients will undergo a rigid or flexi sigmoidoscopy examination of their large bowel to look for the causes of any problems, followed by treatment if necessary, all within a few hours. When available please indicate recent FBC results.

Our consultants specialised in:

Please indicate which of the following symptoms are present:

Rectal bleeding
Persistent diarrhoea
Stool culture result if available
Previous haemorrhoids treatment
Rectal Pain
Previous Anal fissure treatment
Previous flexible sigmoidoscopy/colonoscopy
Latest Full Blood Count
Any other relevant information
  • Private Secretary Ms Kim Levendale
  • E-mail
    mvarcada.practice@nhs.net
  • Phone
    02077940500 ext: 34273
  • Mob:
    07914 803818

  • NHS secretary Ms Patricia O’Donoghue
  • E-mail
    patricia.o’donoghue@nhs.net
  • Phone
    02074726259 (direct)
  • Fax:
    02074726711