Patient Self Referral Form | St Josephs Hospital - Newport South Wales
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Patient Self Referral Form

With significant demands on the healthcare providers and the NHS, patient are finding it increasingly difficult to see a healthcare professional as well as accessing vital diagnostic services. As a result, patients are now seeking alternative sources.

When this involves an MRI scan, the Advanced Diagnostics department in St Josephs Hospital can now offer a self-referral pathway for imaging for patients that meet the specified criteria.

The following criteria will need to be met in order for a self-referral scan to be performed:

  • A person over 18 years of age.
  • A fully completed questionnaire must be provided.
  • The scan must not be to monitor the progress of malignancy.
  • The anatomical area to be scanned must be one from the accepted list.
  • The patient must provide details of a responsible clinician (GMC or HCPC registered) for the results to go back to for discussion.
1
Patient Details
2
Scan Details
3
Clinician Details
4
Safety Check
5
Declaration

About the Patient

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