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Self-referral – making your own request for care – means that you seek care by independently sending a referral to a specialist clinic. The aim is to reinforce your position as a patient and improve access to the healthcare system.

Your self-referral is assessed in the same way as a referral from a doctor. It is up to each specialist clinic to decide on the type of care you will receive and at which level. This means that you can be referred to your health centre or to self-care.

How to submit your care request

You can submit your care request in two ways. Either through 1177 Care Guide e-services, or by submitting a form.

1177 e-services

To make your own care request using 1177 Care Guide, you simply log on to and choose the clinic you wish to send your care request to. There you will find the Self-care request section. Fill in the form and click on Send. The form will then be sent directly to the clinic in question.

NOTE: At present, not all clinics offer the possibility of submitting your self-care request via 177 Care Guide e-services. If you are unable to find the alternative among the e-services, you can use a pre-printed paper form instead.

Paper form

If you wish to submit your self-referral request using a paper form, you simply print out the form, fill it in and submit it.

Self-referral form

You fill in all the details and then send the form to the hospital by post. The address can be found on the form. 

Updated: 2017-10-19 13:29