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24 hour advice phone line:
0191 529 7108
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Day care referral

If you need any help using our online referral system, please call the Referrals Team on
0191 529 7100

This page is for healthcare professionals to make patient referrals. The quickest and easiest way to make a referral is to use our online referral forms. However, if you would prefer to print off a form and send it to us by post or fax, you can download them using the links on each service listing below.

Online referral form

Day Care request for assessment

Who is making the referral?

Patient Details

Patient's Next of Kin

Medical Details

Is patient aware of diagnosis?

Yes No

Are family aware of diagnosis?

Yes No

Is patient aware of referral?

Yes No

Are family aware of referral?

Yes No

Other referrals made:

Transport Risk Assessment

Please note: Risk Assessments to be completed prior to patient attending day care. These will be filed in the patients notes