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Get Manchester Children's University Hospital Referral Form

R your patient to see a specific consultant? No Yes If Yes, please name the consultant: Do you think this is an urgent referral? No GDP/GMP DETAILS You are the: General Dental Practitioner (GDP) General Medical Practitioner (GMP) Both GDP and GMP details must be completed for the patient. GENERAL DENTAL PRACTITIONER DETAILS: Name Practice Address Telephone Number GENERAL MEDICAL PRACTITIONER DETAILS: Name Practice Address Telephone Number Yes WHO IS YOUR PATIENT? Gender Female Male.

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