Long Covid Referral Form

Gps: should submit referrals using the electronic form within their EMIS system. 

Other referrers - click the link below to download a blank referral form. The completed form, along with supporting information must be sent by secure email to: LongCovidReferral@lscft.nhs.uk or lcn-tr.lscft.longcovidreferral@nhs.net.

Download the referral form.