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Long COVID referral form

Below are the set requirements that need to be performed PRIOR to referral and results included with proforma are:


To assess and diagnose any organic disease that could prevent referral to the Long COVID Assessment Hub .

ALL TESTS to be performed post COVID and <3 months old. To be performed to assess for any organic disease and alternative cause of symptoms.

  • FBC - anaemia, infection, asthma
  • U&Es –fatigue
  • LFTs –fatigue
  • CRP –inflammation
  • CK –myositis
  • Haematinics (B12, folate and ferritin) –fatigue, anaemia
  • TSH –hypothyroidism
  • Calcium –fatigue
  • BNP –heart failure, cardiomyopathy (not required if had normal echo post infection)

Any omission of the above blood results will lead to referral being rejected.

Post COVID infection and <3 months old – to assess for any ECG abnormalities which would exclude the patient from pulmonary rehab.

To be requested by GP/secondary care physician but does not need to be performed pre referral to Long COVID Assessment Hub. If CT Chest or CXR imaging has performed post COVID infection and reported as normal no further chest imaging is required.


The GP/secondary care physician requesting the investigations is responsible for managing any abnormal results. Any omission of the required investigations may lead to the referral being rejected.

Care referrals

Primary care referrals: completed proforma and results sent via Choose and Book.

Secondary care referrals: completed proforma and results emailed to

Referral form