WAVERLEY PARK OPERATING ROOM
WAVERLEY PARK OPERATING ROOM WAVERLEY PARK OPERATING ROOM
PRIVATE MINOR SURGERY – REFERRALPRIVATE MINOR SURGERY – REFERRAL
Dr Paul M Newman/Dr Sheena Fraser, Waverley Park Operating Room,Dr Paul M Newman/Dr Sheena Fraser, Waverley Park Operating Room,
19 Dinmont Road, Glasgow, G41 3UJ19 Dinmont Road, Glasgow, G41 3UJ
Tel: 0141 632 8883, Fax: 0141 636 0654Tel: 0141 632 8883, Fax: 0141 636 0654
Patient Identification LabelPatient Identification Label
Referring GPReferring GP
Please indicate the position of the lesionPlease indicate the position of the lesion
ONLY AVAILABLE PRIVATELY AT WAVERLEY PARK OPERATING ROOMONLY AVAILABLE PRIVATELY AT WAVERLEY PARK OPERATING ROOM
Please tick belowPlease tick below
Dermofibromas/ LipomasDermofibromas/ Lipomas
Cysts that have not been infectedCysts that have not been infected
XanthelasmasXanthelasmas
Benign MolesBenign Moles
NeurofibromasNeurofibromas
Skin TagsSkin Tags
Any benign lesion Any benign lesion
Referral Type Referral Type
PrivatePrivate
DiagnosisDiagnosis
Reason for ReferralReason for Referral
P.M.HxP.M.Hx
RxRx
AllergiesAllergies
High Risk InfectionHigh Risk Infection
YES NOYES NO
HIV Hep B Hep CHIV Hep B Hep C
