Request referral forms

Download digital forms or request printed copies.

Digital referral forms

To optimise your convenience, SCP Radiology now offers our referring doctors an editable and downloadable digital referral form. The form can be set to the specific branch your patient would need to visit and sent to the corresponding email address. You will find the branch email address details at the “PREFERRED BRANCH” option on the form.

Note that you would require Adobe Reader to access the digital referral form.

*Please note that digital submissions are only processed during normal operating hours.

Printed referral forms

Should you still prefer printed copies to be delivered to your practice, or if you are a “first-time” referrer to SCP Radiology, please complete the form below to submit your request.

*Note that this form is only for ordering of printed copies, which are not personalised*

"*" indicates required fields

Physical Address


Enquire here about the cost of a procedure and, if funded by a medical aid, the extent of cover provided.

SCP’s services are offered at medical aid rates.