MKCCG Self-referral Form

 

In order for us to proceed with your self-referral, we will need to contact your GP to ensure suitability.

 

Please give us a little more information about the events/reasons for this 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.