Oxford Genetics

Once you have spoken with a GP and agreed that a referral to Oxford Genetics is the appropriate course of action, you will need to download and complete the form below and return this to the surgery before your referral can be sent.

Oxford Genetics Questionnaire Download

The form should be printed and completed; this can then be returned to the practice in the following ways:

Scan the document and then upload it using the button below, or
Post your completed form through the surgery door.

File upload

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Telephone number for us to contact you *

File Upload *

Maximum file size: 10MB

Please upload your files to the practice here. We accept tiff, jpg, png, gif, txt, Word and pdf files, up to a total upload size of 10MB.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.

I consent to the practice collecting and storing my data from this form.

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Oxford Genetics

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