Referral form

Hampden Radiology
Department of Radiology
Stoke Mandeville Hospital
Mandeville Road
Aylesbury HP21 8AL
Tel. 01494 411248
Fax. 01494 372121

A referral to Hampden Radiology from your GP, Hospital Consultant or Healthcare Practitioner (eg. Physiotherapist, Chiropractor) is required for all diagnostic imaging and image guided procedures.

You will be sent an appointment once the referral form has been received. You will be able to reschedule the appointment if the time and/or date are not convenient. You may have to go to a specific hospital to have your scan or procedure, as not all hospitals have facilities for some of the more complex investigations and treatments we perform.

We are happy to answer any questions you may have including requests for information about fees for scans and procedures for self-pay patients, please use our enquiry form.

Further information for patients about scans and radiological procedures is also available at:

Referral Form

Referral forms are available for download, and can be posted, faxed or emailed to Hampden Radiology.   Download PDF file