Login | Text size A A A | Text version
How to find us

our Zone
Pattens Lane
Rochester
Kent ME1 2RB

How to find us >

What you say

Balfour centre speech bubble

Tell us

Your experience is important to us and we are keen to hear from you about how we can continue to improve our services. Tell us >

Referral form

ourZone

Patient details
* required
For example, Mr / Mrs / Ms / Miss
* required
* required
* required
* required



* required
* required
   

* required

GP details
* required
* required

(if known)

* required
* required
* required
* required
* required

A limited number of places are available on specially equipped ambulances for people unable to make their own arrangements to attend the centre. Please indicate below whether transport will be required after all alternatives have been explored.

Will transport be required?: * required


Referrer details
* required
* required
* required
* required

You will see a thank you page once the form has been submitted. If you do not see this page then you have overlooked to complete some of the required fields. Please check the form, complete the missing details and resubmit. Thank you.

* required
Captcha Image - Please enter the number displayed on this image