Ultrasound Self-Referral

01277 623055

info@oakdinclinic.org.uk

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Name

Welcome to our Ultrasound Self-Referral page.

Just fill in this quick and easy form, and we’ll be in touch to arrange your scan.

Your Details

Title *

First Name *

Last Name(s) *

Telephone *

Email address *

Your GP's details

GP's Name *

GP's Practice Name *

GP's Practice Address *

GP's Telephone *

GP's Email

Services

Which ultrasound service(s) do you require?

(Don't worry if you're not sure - just tick "I don't know").

Services Required

I don't know

Gallbladder

Gallbladder and Liver

Abdomen (pancreas, spleen, kidneys, bladder, liver, gallbladder)

Renal Tract (kidneys and bladder)

Bladder (pre and post mic)

Scrotal

Aortic aneurysm screen

Soft tissue lump

Epigastric hernia

Groin hernia

Single joint

Multiple joints

Joint injection

Pelvis (non-gynae)

Gynae pelvis (TV)

Wellman check (abdomen, scrotal, aorta, bladder, pre and post mic, prostate volume)

Wellwoman check (abdomen, aorta, bladder, pre and post mic, gynae pelvis)

Other

Reason for Scan

Please tell us briefly why you'd like to be scanned

Reason for Scan

Note

If you have any relevant documents you'd like us to see (for example, a doctors' letter), please let us know when we speak.

You can also email PDFs of these to scans@oakdinclinic.org.uk

Submit Scan Request

Thank you for filling out our Ultrasound request form.

Please check you're happy with the details you've given, then press "Book".

We'll get in touch with you to discuss things, and to book your appointment.

We look forward to seeing you at Oakdin Clinic.

Our Services

Cosmetic Gynaecology
Urology
- Vasectomy
- Adult Circumcision
Ultrasound Scan
Private GPs
Orthopaedics (Hand and Wrist)
Dermatology
Audiology

Contact

01277 623055

contact@oakdinclinic.com

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Oakdin Clinic is a trading name Oakdin (UK) Limited. Registered in England and Wales. Company no.04509951 Registered office: Room 44, Millfield Business Centre, Ashwells Road, Brentwood, Essex, CM15 9ST © Copyright 2018. All Rights Reserved.

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It is extremely important for patients to please familiarise themselves with our Covid processes before attending the clinic, in order to ensure that your visit runs as smoothly as possible.

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