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Track a referral

Track a Referral
Required fields are labelled
You must be aged 13 or over to complete this form yourself

If you have previously contacted PALS please continue to contact them using these details:

Portsmouth Hospitals NHS Trust
Patient Advice & Liaison Service
Room 102 – Management Centre
Portsmouth
PO6 3AD

Otherwise please fill in the below form

Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you
Who were you waiting to be referred to?
Can we contact you by email?
Can we contact you by text message?