Reflux Testing

Consultant Referral Form

For Healthcare Professionals Referring Patients for Reflux Testing
Why Refer to The Functional Gut?


The Functional Gut Clinic works closely with healthcare professionals to provide expert reflux diagnostics, helping patients receive accurate assessments and tailored treatment plans.

  • Fast access – No waiting lists or delays; patients can be seen as soon as possible.

  • Specialist-led diagnostics – Using the latest technology to investigate reflux symptoms.

  • Referral support – We assist consultants, GPs, and dietitians in identifying underlying conditions and treatment pathways.

  • Patients remain under your care – This is a diagnostic service, and all referred patients remain your patients, ensuring continuity in treatment.

Simply complete the referral form below,

and we’ll take care of the rest.

Healthcare Professional Information

Patient Information

Payment method?
Select the insurance provider

Patient's Health Status and History

Please upload relevant test results and other supporting documents

Select the Required Tests