Please complete the following form. Please note that in order for us to proceed with your self-referral, we will need to contact your GP to ensure suitability.
For heart patients, we also ask for some brief background information about the events/reasons for the diagnosis and the approximate date of diagnosis.
If your diagnosis or surgery was recent (within the last 6 months), you should be contacted by the Milton Keynes University Hospital Cardiac Rehabilitation team (Phase III) This course should be completed before coming to us for Phase IV.