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 [email protected] or post it to Sapphire Clinics, PO Box 1436, Sunderland, SR5 9UE, 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

Guardian / Carer

Patient Details

Patient Location

Unfortunately, we cannot treat patients who are resident in the Isle of Man due to the current laws regarding importation of cannabis medications to the island.

Clinical Details

Please attach a copy of the ‘patient summary sheet’ from their medical record
Maximum upload size: 5MB

Referral Source

Please tell us your relation to the patient. *
You must select one of these options

Details of Referral Source (Your Details)

Details of Patients GP

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