​​​​​​Referral forms - Mersey and West Lancashire Teaching Hospitals NHS Trust

Please note all referral forms should be printed off and hand written / typed, then forwarded in the usual way to the trust.

The forms cannot be emailed and can only be submitted by post.

Please click the link below to view the relevant referral forms within each department.​​​

Referral Forms​

​Diabetes

​Adult Diabetes Outpatient Referral Form

​​Neurophysiology ​

Please note: Referral forms only accepted via ERS

​EMG Conduction Studies Referral Form​

​​Palliative Care

​Specialist Palliative Care Services​

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