GP Request an Appointment | RPH 2023 Website

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Regent's Park Healthcare

Providing World Class Heart Care since 2002

Request an Appointment

0333 222 4034

GP Referral Form

Complete the form below and we'll get in touch to confirm your GP referral.

Appointments are typically confirmed within 16 working hours. If you need your patient to be seen more urgently, call us directly on
+44 (0)333 222 4034.

Our Customer Services Centre normal operating hours are Mon-Fri: 9am-5pm.

For medical emergencies please call 999.

Choose an option

GP Title

GP First Name

GP Last Name

GP Email

GP Postcode location

Code

GP Phone

Patient Title

Patient First Name

Patient Last Name

Postcode location

Date of Birth (Day/Month/Year)

Code

Phone

Choose your Heart Clinic:

Cambridge Heart Clinic

Dorset Heart Clinic

Peninsula Heart Clinic

Happy to be seen at any Clinic

If you have a preferred doctor you would like your patient to see, please state:

Choose your Consultation Option *

Face to face consultation

Telephone consultation

Video consultation

Choose your investigation (if known)

Remote 24hr ECG monitor

Echocardiogram

Resting ECG

Exercise ECG

Ambulatory BP monitor

Blood tests

Cardiac CT Scan

Cardiac MRI scan

Other - please state below

Type the detail of your enquiry

Preferred Date to be Seen

Preferred Time to be Seen

09:30

If applicable, please upload your referral letter or other useful information here:

Upload File

Upload supported file (Max 15MB)

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Regent's Park Healthcare is a Limited Company Registered in England and Wales No. 8983623 Registered office: Close Gate House, Salisbury, Wiltshire, SP1 2PB, United Kingdom
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