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Nutrition and Dietetic Referral Guidelines

Inpatient Referrals

Patients can be referred to the dietitian by telephoning the dietetic department as indicated below:

Cheltenham General Hospital

 Please phone referrals  through to

Cheltenham General Hospital

Tewkesbury Hospital

Cirencester Hospital

Moreton in Marsh Hospital

 

Gloucestershire Royal Hospital

Please phone referrals through to

 Gloucester Royal Hospital.

Dilke Hospital

Lydney Hospital

Stroud Hospital

 

The following information is needed for a referralReferral Checklist

  • Patient's name
  • MRN
  • Location of patient. (Hosital and Ward )
  • Date of Birth
  • Reason for Referral
  • MUST  (Malnutrition Universal Screening Tool) Score

 

Outpatient Referrals

To refer a patient to the dietetic outpatient service. Please click on the link below which will open a referal form which can be printed, filled in and then posted or faxed to the address at the bottom of the form.

 Please ensure the form is filled in fully othewise it may be sent back to you

 

Health Professionals referring from Gloucester Hospitals NHS Foundation Trust

For referrals for  Gloucester Royal Hospital, Stroud, Cam, Cinderford please use Gloucester Royal Hospital referral form

For referrals for Cirencester, Tewkesbury, Moreton in Marsh, Bourton on the Water please use Cheltenham General Hospital referral form

 

Heatlh Professionals referring from Gloucestershire PCT

For referrals for  Gloucester Royal Hospital, Stroud, Cam, Cinderford please use Gloucester GP referral form 

For referrals for Cirencester, Tewkesbury, Moreton in Marsh, Bourton on the Water please use Cheltenham GP referral form