Use the NeuroWellness stroke referral form above. Submit the patient’s name, age, symptoms, time of onset, current hospital, and contact number. Upload any available reports or scans. You will receive an immediate auto-confirmation email. The coordination team will contact you directly to discuss triage and specialist pathway. For urgent cases, call directly — the form is best for structured, non-emergency referrals.

Both referring doctors and families can use this form. Select your role in Section D — the form supports GP/doctor referrals, family-initiated specialist requests, and self-referrals. For a stroke emergency, always call 108 and go to the nearest hospital first. This form is for triage coordination, not real-time emergency response.

Yes. The form uses SSL encryption to protect all data in transit. Patient information is used solely for stroke triage coordination and specialist referral purposes. Submissions are received only by the NeuroWellness coordination team and are not publicly accessible or shared with third parties.

Required: patient name, age, gender, current location, symptoms observed, time of onset (or last known well time), patient stability status, your name, your role, and contact number. Optional but helpful: suspected stroke type, current medications, attending doctor name, and uploaded CT scan or MRI reports. The more details provided, the faster and more accurately we can triage and coordinate.

Yes. Select “Second Opinion / Post-Stroke Review” as the referral type. Upload relevant scans, reports, and current treatment details. The NeuroWellness specialist team will review the case and contact you to schedule a specialist consultation. Second opinions are available for stroke, TIA, and cerebrovascular cases — covering imaging review, treatment assessment, and rehabilitation planning.

No. The NeuroWellness Stroke Referral Network is a Phase 1 triage coordination platform — not a 24/7 emergency response service. The referral form is for structured transfers, specialist coordination, and second opinion requests. In a stroke emergency, call 108 immediately and go to the nearest stroke-ready hospital. Do not wait for a form response.

The form is designed for structured, non-emergency intake — it captures all clinical details, onset time, and reports in one place and is available at any hour. Calling directly is better for urgent cases needing immediate verbal coordination. Both options are available — use the form for structured referrals, call for real-time urgent discussion.