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Direct Access Endoscopy

 

St. Vincent’s Private Hospital offers direct access endoscopy services to referring physicians to expedite patient care.  These services are provided by a team of consultants with expert knowledge and clinical experience in the fields of gastroenterology and general surgery. Referrals are triaged by a consultant and suitable patients are booked into the next available slot.

Our services include colonoscopy, bronchoscopy, sigmoidoscopy and gastroscopy.

Appointments

To access this service, referring doctors are requested to complete the online form below.  Alternatively,  our Direct Access Endoscopy form can be printed off and faxed back to (01) 263 8290. This referral form is provided for GPs use only and should not be used by patients.

We endeavour to respond to your request as soon as possible with a suitable date and time.

Patient Details

Name:*

Please enter your name.
Date of Birth:*

Tell us your reason for visiting.
Telephone*:

Please enter a valid phone number.
Mobile*:

Please enter a valid mobile number.
Address*:

Please enter the patient address.

GP Details

Name:*

Please enter your name.
Email*:

Please enter a valid email.
Telephone*:

Please enter a valid phone number.
Fax*:

Please enter a valid fax number.
Mobile*:

Please enter a valid mobile number.
Address*:

Please enter your address.

Referral Information

Priority: Urgent Soon Routine
Medical Insurance: VHI Aviva Quinn Other Self
Please select an insurance option.
Procedure Required: OGD Colonoscopy
Please select a procedure.

Gastroscopy Indications

Dyspepsia
Heartburn/Reflux
Dysphagia
Haemotemisis/Malaena
Nausea/Vomiting
Anaemia
Weight Loss
Barrett's Oesophagus
Varices Assessment
Epigastric Pain
You have selected the OGD procedure. Please select gasroscopy indications.

Colonoscopy Indications

PR Bleeding
Altered Bowel Habit
Anaemia
IBD Surveillance
Family History of Colon Cancer
Previous Polyps
Abdominal Pain
You have selected the Colonoscopy procedure. Please select colonoscopy indications.
Other Indications:

Duration of Symptoms:*

Please enter the duration of symptoms.

Past Medical History

Current Medications

Is patient on:

Warfarin
Aspirin
Plavix
Is the patient diabetic?*

Type 1
Type 2
Not Diabetic
Please select one.
Indication for Treatment:*

Please complete Indication for Treatement field
Please advise patient to take Blood Pressure meds with a sip of water on the morning of procedure. For Colonoscopy, please give patient script for Moviprep X 2 sachet for day prior to procedure.
 

Thank you for your referral which has now been received by our team. For any queries relating to your online submission for Direct Access Endoscopy referrals, please telephone (01) 263 8213 or email endoscopyreferrals@svph.ie.

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St. Vincent's Private Hospital is a member of St. Vincent's Healthcare Group.
Registered in Dublin, Ireland. Company Registration No. 338585. CHY No: 14187
Registered Office: Elm Park, Dublin 4.