We request you as referring practitioner to complete the form below in full and to attach all the relevant documentation, so that we can schedule an appropriate appointment for the patient. If you have any questions relating to the referral procedure, please phone the Medical Oncology Planning Office at (024) 36 188 00.

All image material should preferably be sent via Twiin. There is no need to mail these images in addition. If sending via Twiin is not possible, the images can be sent in on a CD/DVD to:

Radboud university medical center
Medical Oncology Secretarial Office, hp 452
PO Box 9101
6500 HB Nijmegen