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CORONAVIRUS (COVID-19)

*UPDATED* Hospital visiting changes, home testing kits, Vaccine info, general info and guidance for public, NHSGGC staff, and community-based services.

Referral Form

  • If you wish to make a referral please fill in the Referral Form below.
  • Referrals should be made by your movement disorder specialist.
  • If you need to discuss a referral  please contact the DBS team.
  • If you are a referrer, you may get additional information from the Early Stimulus tool for Parkinson's disease.
  • For further information on Tremor please click on the Medtronic Assess DBS ET link. 
  • If you want a print version of the Referral Form to send by email/post/file please fill-in, print and send to the contact on the form or the bottom of the page.

Referral Form to the National Deep Brain Stimulation Service for Movement Disorders

Patient details.
Patient details.
Patient details.
Patient details.
Patient details.
Patient details.
Referrer details.
Please send clinical letters if necessary to administrator.
Medical history.


Medical history.


Medical History.


Cognition and mood.


Cognition and mood.


Cognition and mood.


Speech and gait.


Speech and gait.




 


Please Note: That after submission of this Referral Form you will directly receive a copy into the email address you have provided.

If you wish further information please contact the DBS administrator as below.

Margaret Reynolds, 6th floor, Institute of Neurosciences, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, Tel: 0141 232 7512 or [email protected]


 

 

Last Updated: 23 August 2019