Use this service to request a referral from a doctor.
You can use this service if you:
- are registered at the surgery
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on Colne Medical Centre 01206 302522 or Alresford Branch Surgery 01206 302522 or visit the surgery in person.