Healthcare Professionals

Healthcare Professionals: Online Referral

A quick and efficient way to refer your patient to the Medilink Dispensing and Home Delivery Service.

Register your patient online

To help make things easier, you can complete the online registration form below if you have a patient you'd like to refer to the Medilink^® service.

Alternatively, you can continue to email or call your local Medilink^® Dispensing Care Team who will help set up your patient on to the Medilink^® service.

Registering Nurse/HCP Details:

Full Name*

Job Title*

Hospital*

Telephone Number*

Email Address*

Patient Details:

Title (Mr, Mrs, Miss etc.)*

First Name*

Surname*

Address*

Postcode*

Email Address

Contact Telephone number*

Date of Birth (DD/MM/YYYY)*

NHS or CHI number*

Please select the preferred Medilink dispensing care centre*

Patient Medical Details:

Operation Type*

Date of Operation, if known (DD/MM/YYYY)

Is the condition*

Date of Hospital Discharge, if known (DD/MM/YYYY)

GP Details:

GP Name

GP Surgery Address*

Postcode*

Telephone number*

Products Required/Discharged with*:

Please note that we will automatically add the essential dry wipes and disposal bags with the order, unless otherwise requested.

Product One

Product One Qty

Product Two

Product Two Qty

Product Three

Product Three Qty

Product Four

Product Four Qty

Product Five

Product Five Qty

Any additional comments: (i.e. delivery instructions, when order is required or customisation/cutting requirements):

Man on the phone to Medilink Customer Services

Need support or advice?

If you need any further support or advice, then please contact Medilink® today. You can call us Monday to Saturday, from 9am to 5pm, on Freephone 0800 626388.