Strike action is taking place in April. We'll contact you directly if your or your child's care is affected to rearrange your appointment as quickly as possible.

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Innovative eye gene therapy performed at Evelina London

Description: Specialists have joined forces to carry out revolutionary eye gene therapy for children with a rare form of blindness.

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nutrition and dietetics referral form

Description: Evelina London Paediatric Dietetics Referral Form (General Paediatric Dietetics Outpatients) DOES NOT INCLUDE: Specialist Se
Url: /resources/our-services/hospital/nutrition-and-dietetics/nutrition-and-dietetics-referral-form.doc

Community specialist feeding clinic referral form questionnaire and food diary

Description: REFERRAL TO SPECIALIST COMMUNITY FEEDING CLINIC Notes for use: this is an electronic form; you will be able to enter text only in the boxes allocat
Url: /resources/our-services/community/specialist-feeding-service/Community-specialist-feeding-clinic-referral-form-questionnaire-and-food-diary.docx

bereavement referral form

Description: Parent Bereavement Counselling Referral Form We accept referrals for parents of children with life-threatened, life-limited diagnosis and bereavement. W
Url: /resources/our-services/hospital/counselling/bereavement-referral-form.docx

Short stature referral form

Description: Short stature referral form
Url: /resources/our-services/hospital/endocrinology/short-stature-referral-form.docx

chronic pain referral form

Description: EVELINA LONDON CHILDREN’S HOSPITAL OUTPATIENT PAEDIATRIC CHRONIC PAIN SERVICE REFERRAL FORM Thank you for referring a young person in you
Url: /resources/our-services/hospital/chronic-pain/chronic-pain-referral-form.docx

hearing implant referral form

Description: Paediatric Hearing Implant Referral Form Once completed, please send this form and attachments to one of the following: FAO Katherine Wilso
Url: /resources/our-services/hospital/audiology/hearing-implant-referral-form.docx

hearing implant patient transfer form

Description: Patient Transfer Form + protocol From: ] To [insert name of receiving CI centre] Reason for transfer: Has patient been seen at any
Url: /resources/our-services/hospital/audiology/hearing-implant-patient-transfer-form.docx

Post-COVID referral form for local paediatricans

Description: A referral form the the long-COVID service at Evelina London
Url: /resources/our-services/hospital/long-covid/post-covid-referral-form-for-local-paediatricans.docx

Acute kidney referral form

Description: Referral form for our acute kidney injury clinic
Url: /resources/our-services/hospital/kidney/acute-kidney-referral-form.docx

Heart referrals

Description: How to refer to the heart (cardiology) service.
Url: /our-services/hospital/heart-services/referrals.aspx

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