Fertility Service Referral Form

Author:    Jonathan Skull  - Clinical Head of Assisted  Conception, Jessop Fertility, Sheffield Teaching Hospitals 

Date published: July 2021 (updated February 2024)

Date to review: July 2024

Description: 

All referrals into the NHS fertility service at the Jessop Wing must be accompanied by this pro forma and sent via the electronic-Referral Service (eRS).  All fields must be completed.  Failure to provide all details requested will result in the referral being returned.  If the case is complex please provide further details in a separate letter.

Details must be completed for both partners even if partners are registered with different GPs (either GP may refer).

All patients are eligible to be referred to the NHS Fertility Clinic at the Jessop Wing for investigation of their fertility problems even if they do not fulfil the criteria for assisted conception.