Self Referral

Your medical information is personal to you. We require consent to share this information and will only do so with your permission or if required to do so by law.

Heath Lodge Clinic and Daleswood Health are separate companies with their own CQC and ICO registrations.

To provide the highest quality of medical care Daleswood Health will share information collected in this form with Heath Lodge Clinic. Once you have had your scan the report will be shared with a healthcare professional. Your NHS GP may be unaware of your request until they receive your report and may not automatically make an appointment to discuss this. Alternatively you may not want your NHS GP to receive a report.

If you would like the option of seeing a private doctor to discuss your scan report, go through your images, examine and provide treatment options you can ask Heath Lodge Clinic to share the images and report with Daleswood Health. You may prefer or find it more convenient to speak to the same doctor you discussed having your scan with. Please be aware there will be a fee charged for a follow up consultation with a doctor at Daleswood Health. In either case you will need to give Heath Lodge Clinic consent to share your information.

Daleswood Health will share the information you enter in this form and provide during your triage appointment with Heath Lodge Clinic.