Referral forms

Referral forms must be legible (it is possible to type the information into the available PDFs) and provide:

• patient's full name
• date of birth and NHS / hospital number
• patient's postcode
• name and address for invoicing for non-NHS referrals
• full name and address of referring clinician
• referral reason and test/s required
• information regarding any known or suspected infection risks (e.g. HIV / Hep B & C / TB) must be clearly documented

Referral forms

• Oxford Genetics Laboratories referral form (pdf, 390 KB)
• Cytogenetic studies for haemato-oncology or solid tumour referrals (pdf, 2.6 MB)
• Inherited coagulation bleeding, thrombotic and platelet disorders testing request form (pdf, 193 KB)
• Disorders of iron regulation request form (pdf, 250 KB)
• Molecular haematological oncology testing request form (pdf, 308 KB)
• Solid tumour molecular diagnostics request form (pdf, 274 KB)
• Genotyping of haemoglobin disorders request form (pdf, 297 KB)
• Genotyping of haemoglobin disorders - prenatal diagnosis request form (pdf, 285 KB)
• Rare disease in molecular haematology - genomic panel request form (pdf, 275 KB)

Pre-referral forms

• Calcium disorders testing request form (pdf, 206 KB)
• Familial hypoparathyroidism testing request form (pdf, 194 KB)
• Mitochondrial diseases request form (pdf, 270 KB)
• Microsatellite instability (MSI) / methylation analysis tumour profiling request form (pdf, 333 KB)
• Familial hypercholesterolaemia testing request form (pdf, 306 KB)
• Endocrine neoplasia testing request form (pdf, 200 KB)

Whole Genome Sequencing (WGS)

Referral forms and sample requirements for whole genome sequencing are available on the following website:

West Midlands Regional Genetics Laboratory - bwc.nhs.uk

Specific queries about WGS

Email: bwc.centralsouthglh@nhs.net