E-referral request

Use this service if you haven’t received your e-Referral information within 2 weeks, or your password is missing.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on Brookside Surgery 0118 966 9333 or Chalfont Surgery or Winnersh Surgery or Wilderness Road Surgery .