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.

If you would rather send a written referral or would like to send more detailed past medical history/medication record, please send this to Sapphire Medical Clinics, 10 Harley Street, London, W1G 9PF. Please provide the patients NHS number, email address, and your GMC number.

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