GP e-Referral Form
Thank you for choosing to refer your patient to Aurelius Hospital Nilai. The GP e-Referral form has been created to allow you to refer patients quickly via a secure website connection. To start the referral process, kindly complete this form.

Once you have submitted the referral, you will receive an automated email confirming that your referral has been received, as well as a softcopy of the form which you can print out for your patient.

We look forward to collaborating with you on your patient’s treatment plan.
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Email *
Name of patient *
Sex *
NRIC/Passport *
Age *
Contact Number of Patient *
Email Address of Patient
Referral To *
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