Information for GPs and Referring Specialists

Pinhole Clinic accepts referrals for consultant-led interventional radiology assessment and treatment.

Referral pathway

Referrals can be made by filling the following form and our team will reach out to you.

Please include relevant clinical history, imaging reports (and images where possible), and any prior specialist correspondence.

Referrer details

Referrer name

Referrer role

Specialty

Practice or hospital

Email address

Phone Number

Patient details

Patient full name

Patient date of birth

Patient email address

Patient phone Number

Clinical information

Condition / procedure requested

Is the diagnosis confirmed by a specialist?

Has the patient had imaging confirming the diagnosis?

Clinical summary

Insurance

Insurer

I confirm that the patient has consented to this referral being shared with Pinhole Clinic™ for the purposes of arranging consultation and any subsequent care. I have read the Privacy Policy.

By submitting, you agree to our terms & conditions.