Urgency: Routine/urgent
Sub-speciality: e.g. Cornea
Hospital preference, if expressed.
Please include NHS number, if known
Please do not provide any information in the email body as all essential information (see checklist below) should be captured in the GOS 18 or equivalent proforma
GOS 18/equivalent proforma (essential to submit referral)
Other relevant test results e.g. visual fields
GOS 18/equivalent proforma checklist
Optometry practice name + address + phone number
Optometrist name
GP name + address
Patient’s first name, surname + DOB
Referral urgency
Ophthalmology sub-specialty
Hospital preference, if expressed
Any other relevant information
How to refer
How to refer
How to refer