Referral Information

Should you wish to make a referral into the Lymphoedema Service we do ask that a referral form be completed or alternatively a letter can be sent to us at our main office at Southgate Moorings, Gloucester Docks, Kimbrose Way, Gloucester, GL1 2DB.


Gloucestershire Lymphoedema Service Referral Criteria

Referral Criteria


We have two referral forms as follows:

Standard Referral - For all patients with a lymphoedema who require long term input from the Lymphoedema Service

Please click here to download a form

Palliative Care Referral - This form to be used for patients who require short term intervention or who are palliative who are nearing their end stages of life but require input from the Lymphoedema Service.

Please click here to download a form

Should you wish to speak to a member of the team, please telephone the main office on 0300 4228750