COVID treatment Referral form
Please do not complete this form if you are NOT SEVERELY HIGH RISK (CLINICALLY SHIELDING). You will know if you are in this category as you will have received a letter or correspondence from us or a hospital specialist last year. If you've never been advised that you are COVID high risk then DO NOT fill this form and request a call with the doctor to discuss first.
Please DO NOT complete this form if you do NOT have a POSITIVE PCR test
Even if we refer you based on incorrect information you supply us, you will not get the treatment as the hospital unit will decline the referral. Please do not fill out the form dishonestly as you will be WASTING NHS TIME
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