Symptomatic FIT Service

Public Health Wales Screening Laboratory

Telephone: 01443 235131

Email: phw.fit.symptomaticreferral@wales.nhs.uk

Web Referral Form

This form is intended for requesting Faecal Immunochemical Tests (qFIT/FIT) by a clinician according to service level agreements made with participating Health Boards. (Locations which fall within Aneurin Bevan, Cwm Taf or Hywel Dda Health board should NOT use this form - please refer to local guidance)

Requests made using this form are still accepted – However, we encourage you to begin using GPTR/WCP as soon as possible.

Please complete all the questions below for the referral to be processed:

Please check that the information you enter on this form is correct. If the patient details do not match our records, we may not be able to accept the referral/sample.