Refer a Private Patient

Referral Form

Private Services Offered

  • General Urology
  • Female Urology and Incontinence
  • Vasectomy Reversal by Advanced Microsurgery
  • Functional Urology & Urodynamics
  • Painful Urological Conditions
  • Inflammation of Urinary Tract
  • Medical & Surgical Treatment of Benign Prostatic Enlargement
  • Holmium Laser Treatment for Prostate
  • Rezum- Water Vapour (Steam injection) Treatment for prostate 
  • Assessment of Urinary stones & Treatment

How to refer a Private patient?

Please fax your referrals to 01642 337510 with the patient’s contact details or use the form below.

What level of services we assure?


We will contact the patient and arrange an appointment that is convenient for the patient, usually within 1 week in the hospital.


We will inform the patient about the level of fees and expenses they will have to pay. For insured patients, we will try our best to charge the agreed level of payments with the insurance companies except the excess and exclusions that will be payable by the patients.

Management Plan

After the initial assessment, we will send the printed communication about the assessment and management plan within 48 hours. If we are provided with your fax number or NHS email address, you will receive them even earlier.

Customer Care

The patient will receive direct phone number (voice mail) and email address to contact the consultant for any post operative problems or queries.

Refer a Private Patient

Please receive the consent from the patient to use this electronic medium for a referral.

Fax: 01642 337510 Voice mail: 01642 699066

    Patient's Consent:

    Kindly confirm that the patient has agreed to send their personal details via internet