Secretaries: 2 week wait referral status

Please complete this form if you were referred by your GP under the 2 week wait pathway (urgent) but have not heard anything back after 14 days. We understand that it can be a really anxious time and on completion of the form below we will endeavour to chase your referral with the hospital team.

Due to the coronavirus pandemic, you may have to wait longer for your urgent referral. The breast clinic inparticular are having longer waits then usual (3 to 4 weeks). Your first appointment may be over the phone or at the hospital. It’s important that you keep your appointment, so do let them know if you need to change it.

To contact the hospital department please call 01926 495321 and ask switchboard to put you through to the relevant department.

More information on 2 week wait referrals

Please do not write any symptom queries on this form. Any symptom queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 2 working days to complete. Please DO NOT call before 2 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

Secretaries: 2 week wait referral status

Full Name:

Date of Birth (DD/MM/YYYY)

Contact Number (preferably mobile):

Address:

Date you were referred by the practice: Please only complete this

Which department where you referred to?e.g. breast clinic or colorectal team.

I confirm that my referral is a 2 week wait urgent referral

I confirm I have not heard anything back regarding my 2 week wait referral by either phone or letter.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Clarendon Lodge Medical Practice • Clarendon Lodge, 16 Clarendon Street, Leamington Spa, Warwickshire, CV32 5SS.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.