Referrals Contents Self-Referral Track a Referral Self-Referral Mental Health Exersise Maternity One Life Physiotherapy Sexual Health Smoking Cessation Young Carers Youth Counselling Ask us about referrals Track a Referral NHS e-Referrals James Paget University Hospital referrals If your referral was made via Victoria Road Surgery, please complete the form below. Track a Referral About youYour Name First Last As it appears on your passport.Your Current Postcode The one you used to register with your GP.Your Date of Birth Day Month Year Your date of birth is required to verify your identity.Sex Male Female Other As on your medical record.Your Phone Number OptionalThe practice may use this number to contact you about your requestYour Email Optional This email address can be used to contact you about your request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.Your ReferralWho were you waiting to be referred to? Comments OptionalThis field is for validation purposes and should be left unchanged.