Refer a Patient

Please fill in the form below to refer a patient to Sapphire Clinics. You will receive a confirmation email once the referral has been received.

Alternatively, you can download the form below and send to referrals@sapphireclinics.com or post it to Sapphire Medical Clinics, 10 Harley Street, London, W1G 9PF along with any additional past medical history / records. Please ensure you provide the patients NHS number, email address, and your GMC number.

Download Referral Form
Referral Form (New)

Guardian / Carer

Patient Details

Patient Location

Clinical Details

Referral Source

Please can you tell us if you are a GP or a Consultant?
Please can you tell us if you are a GP or a Consultant? *

Details of Referring Consultant

Details of Referring GP

Privacy Disclaimer *

This information will be used to create a PKB account and stored securely on the PKB server, a trusted partner of the NHS