How to refer?
- Healthlink
- Complete and submit a direct referral form to us for certain services from the list below.
GP Liaison teams:
Blackrock Clinic: call 01 2064304 or email here.
Hermitage Clinic: email here
Galway Clinic: call 091 785936 or email here.
Limerick Clinic: call 1800 784 000

Direct Referral Forms
If your patient referral request falls under one of the following specialties, please complete and submit the relevant referral form directly to us using the contact information on the form.
- Blackrock Clinic
Blackrock Radiology Referral Form.pdf
Send via Healthmail to radiology@blackrock-clinic.com
- Galway Clinic
Galway Radiology Referral Form.pdf
Send via Healthmail to rad.referrals@galwayclinic.com
- Hermitage Clinic
Hermitage Radiology Booking Form.pdf
Send via Healthmail to radiology@hermitageclinic.ie
- Limerick Clinic
Limerick Radiology Referral Form.pdf
Send via Healthmail to limerick.referrals@galwayclinic.com
Please Note: Patients over 75 years old should be referred to a consultant. They are not eligible for direct access endoscopy services.
- Blackrock Clinic
Blackrock Endoscopy Direct Access referral form.pdf
Send via Healthmail to daycare.unit@blackrock-clinic.com
- Hermitage Clinic
Hermitage Endoscopy Direct Access referral form.pdf
Send via Healthmail to endoscopy@hermitageclinic.ie
- Hermitage Clinic
Hermitage Breast Clinic Referral Form.pdf
Send via Healthmail to: radiology@hermitageclinic.ie
-
Hermitage Clinic
Send via Healthmail to: neurophysiology@hermitageclinic.ie
- Hermitage Clinic
EMG Nerve Conduction Request Form.pdf
Send via Healthmail to: neurophysiology@hermitageclinic.ie
- Blackrock Clinic
Blackrock BRC Cardiology Form.pdf
Send via Healthmail to radiology@blackrock-clinic.com
- Blackrock Clinic
Cystoscopy Direct Access Form.pdf
Send via Healthmail to daycare.unit@blackrock-clinic.com
- Blackrock Clinic
Send via Healthmail to nuclear.medicine@blackrock-clinic.com
- Hermitage Clinic
Cardiology Department - GP Direct Access Referral Form.pdf
Send via Healthmail to: cardiology@hermitageclinic.ie
- Blackrock Clinic
Physiotherapy Referral form.pdf
Send via Healthmail to physiotherapy@blackrock-clinic.com
- Hermitage Clinic
Physiotherapy Referral form.pdf
Send via Healthmail to physio@hermitageclinic.ie
- Blackrock Clinic
Blackrock Pulmonary Function form.pdf
Send via Healthmail to outpatientreferrals@blackrock-clinic.com
- Hermitage Clinic
Hermitage Pulmonary Function form.pdf
Send via Healthmail to respiratory@hermitageclinic.ie
- Blackrock Clinic
Blackrock BRC Cardiology Form.pdf
Send via Healthmail to radiology@blackrock-clinic.com
- Blackrock Clinic
Send via Healthmail to outpatientreferrals@blackrock-clinic.com
- Blackrock Clinic
Send via Healthmail to daycare.unit@blackrock-clinic.com
- Blackrock Clinic
Send via Healthmail to nuclear.medicine@blackrock-clinic.com