PLEASE ENSURE the PATIENT WISHES to BE REFERRED Referral to ‘Newly Diagnosed’ Type 2 Diabetes Patient Education DIABETES EDUCATION REFERRAL FORM ADDRESSES

Referral to ‘Newly Diagnosed’ Type 2 Diabetes Patient Education

CH(C)P / Sector North East Glasgow North West Glasgow PLEASE CIRCLE South Glasgow East Ren Renfrewshire AS APPROPRIATE Inverclyde West Dun East Dun

Name: CHI No:

Patient Address: Tel No: Day: & Postcode Mobile:

D.O.B. (If no CHI No) Patient’s Email Address:

Can we contact you by email: Yes/No GP: Practice Nurse:

Practice Address: Tel No: & Postcode

Date of diagnosis: Clinical Indicators required: (please supply where possible) HbA1c Total Chol HDL LDL BP Waist Circumference Weight BMI Smoker/Ex smoker/Non smoker Diabetes Drugs:

Any other relevant information:

Please return forms to your CRITERIA FOR REFERRAL

Newly Diagnosed Type 2 Diabetes Local Patient Education Administrator (up to 1 year)

Speaks/Understands English (Addresses listed on page 2) Over 18 years of age

PLEASE ENSURE THE PATIENT WISHES TO BE REFERRED Referral to ‘Newly Diagnosed’ Type 2 Diabetes Patient Education DIABETES EDUCATION REFERRAL FORM ADDRESSES

Please send this referral to your local Patient Education Administrator:

North –West (North) North –West (West) North–East

Gillian Braithwaite Gillian Braithwaite Nicola O'May Woodside Health Centre Woodside Health Centre Team Secretary Barr Street Barr Street Community Diabetes Team Glasgow Glasgow Bridgeton Health Centre G20 7LR G20 7LR 201 Abercromby Street Glasgow G40 2DA

South (West) South (East)

Ruth Frew Caroline Nelson Diabetes Specialist Nurse Clerical Officer Gorbals Health Centre Govanhill Health Centre 5 Pine Place 233 Calder Street GLASGOW Glasgow G5 9AW G42 7DR

Renfrewshire East Renfrewshire Inverclyde

Yvonne Leggat Mary Casey or Gillian Lynne Ferrier Diabetes Team Secretary Ashwood Inverclyde Centre for Diabetes Centre Barrhead Health Centre Independant Living RAH, Corsebar Road 201 Main Street 10-16 Gibshill Road Paisley Barrhead Greenock PA2 9PN G78 1SW PA15 2UP Tel: 0141 314 7009 Tel: 01475 714 350 East Dunbartonshire West Dunbartonshire West Dunbartonshire

Amy Carlin for Dumbarton and Vale of for Clydebank: Clerical Officer Leven: Kirkintilloch Health And Care Centre, Ellen Marr Lee-Anne Carmichael 10 Saramago Street, Vale Centre for Health and Vale Centre for Health and Kirkintilloch Care Care G66 3BF Main Street Main Street Alexandria Alexandria Tel: 0141 304 7403 G83 0UA G83 0UA