GP / Optometrist Referral Form

The following form is encrypted at the time of sending and any referral information entered will be deleted after the appointment has been made for the patient. Patient data is not stored but securely transmitted to Mr Agrawal.

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Date of Birth

Right Refraction

Left Refraction

Mr. Pavi Agrawal

Department of Ophthalmology, Queens Medical Centre, Derby Road, Nottingham  Nottinghamshire NG7 2UH
Secretary: Sharna Croft - Tel: 07983 434881

Spire Hospital Nottingham, Tollerton Lane, Tollerton, Nottingham NG12 4GA
Secretary: Abigail Lawton - Tel: 0115 9377683
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BMI Park Hospital, Sherwood Lodge Drive, Burntstump Country Park, Arnold, Nottingham NG5 8RX
Secretary: Dorothy Robinson - Tel: 0115 9662293
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