This form is to be used for adult general fractures and soft tissue injuries. Any injuries to the wrist or hand should be referred on a different referral form.

We DO NOT accept referrals for:

  • Spine injuries including soft tissue/whiplash injuries
  • Children under the age of 16
  • Open fractures, these should always be referred to the Orthopaedic on-call team
  • Dislocated total hip replacements

Further guidance on the Orthopaedic pathways can be found by clicking here.

 

Referral

PATIENT
CONTACT CONSENT
CLINICAL DETAILS
REFERRED BY