Groote Schuur Breast Clinic Referral

Groote Schuur Hospital Specialist Breast Clinic Referral

This form is to be completed for all submissions to the Groote Schuur Hospital Diagnostic Breast Clinic. The form must be completed by a registered medical practitioner. Self referrals will not be accepted.
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Referral to Groote Schuur Hospital breast clinic

I want to refer a patient to the GSH breast clinicAppointment at the High Risk Breast Clinic (This option is only available to doctors working in the breast unit and requires an access code)Internal Breast Unit Booking (This option is only available to doctors working in the breast unit and requires an access code)
IF YOU ENCOUNTER ANY DIFFICULTY USING THE APPOINTMENT SYSTEM PLEASE EMAIL US ON breastsurgendo@gmail.com

Referring Health Care Worker Information
Health Professional Council / South African Nursing Council Registration Number*
Email referring health care worker*
example@example.com
Patient Information
Name of patient*

First NameLast Name
Please provide Hospital / Clinic Number (you can enter 12345 if the patient do not have a number)*
Patient Phone Number
Please enter a valid phone number.

PLEASE NOTE

Make sure you select a date and time slot on the calendar. Once you have selected a time slot a blue box should appear below the calendar reading "You’ve selected 'time' AM on Friday / Wednesday and date" If you now hit submit your patient is booked.
Appointment *Please choose date and time slot before proceeding* *
PLEASE NOTE

Please make sure you click Submit after selecting a date and time.

PLEASE NOTE

Your patient lives in the Mitchells Plain drainage are. There is a Specialist Breast Clinic at Mitchells Plain Hospital on Monday mornings. Please use the link below to the Mitchells Plain Clinic.

Mitchells Plain Breast Clinic

Teenagers

Teenagers are not seen at the breast clinic unless they have a breast lump larger than 4 cm, roughly the size of a golfball, which might need excision. Small lumps in teenagers are almost always fibroadenomas. Lumps in teenagers do not need a biopsy or imaging, just a clinical follow-up. We suggest you follow your patient up in 3 months. If the lump is rapidly enlarging then contact us for an appointment, otherwise explain the benign nature of breast lumps in teenagers to your patient and discharge them to return if the lump continues to enlarge.

If you feel your patient should be seen because of concern please contact us by email at breastsurgendo@gmail.com Please provide the patient name, DOB, and hospital number of your patient in all correspondence.

Appointment High Risk Clinic (Just use the down arrow on the month button until a time appear that will be the next available date, you can select the time to complete the booking)*
PLEASE NOTE

Please make sure you click Submit after selecting a date and time.

If there is no time slot to select move to next month until the time box appears.

Remember the High Rik Clinic only runs every eight weeks.

Incorrect Access code
Incorrect password, please note the high-risk clinic is only for patients with a known high-risk genetic mutation or an IBIS risk calculator score of more than 8% 10-year risk or 25% lifetime risk. Please email us at breastsurgendo@gmail.com if you think your patient needs to be seen in the high-risk breast clinic.

PLEASE NOTE

Make sure you select a date and time slot on the calendar. Once you have selected a time slot a blue box should appear below the calendar reading "You’ve selected 'time' AM on Friday / Wednesday and date" If you now hit submit your patient is booked.
Appointment *Please choose date and time slot before proceeding* *
Should be Empty:

Groote Schuur Hospital Specialist Breast Clinic Referral