Second opinion form

Complete our short form and a member of our team will be in touch to arrange next steps. You will need to confirm that you accept our terms and conditions.

 

Referrer details
Who is making the request for a second opinion?
What is your relationship to the patient?
Type of second opinion
Which type of second opinion would you like to request?
Not all cancer types are currently eligible for a second opinion. If your cancer type is not listed then please contact us to discuss your case.
Patient details
House number or name, building and street
We'll only use this to contact you about your second opinion
Has the patient ever been treated at The Royal Marsden?
How should the medical record review report be sent?
We'll use either the email address or postal address you provided
Should the patient"s UK GP receive a copy of the medical report?
I have read and agree to the terms and conditions
A link to the terms and conditions is at the top of this form