Referral request

Use this service to request a referral from a doctor.

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 Cuffley Village Surgery 01707 875201 or Valley View Health Centre 01707 875223 or visit the surgery in person.