Referrals can be uploaded below and submitted with the Patient Information form OR Faxed to (03) 9576 0019.

If it is urgent we ask the referring doctor to indicate clearly on the referral.
After being triaged the patient will receive a phone call from the secretary with an appointment.

Patient referral

Full name*
Date of birth*
MM slash DD slash YYYY
Phone number*
Doctor's Name
Referring Dr's name*
Upload File
Drop files here or

Max. file size: 5 MB.
Phone
This field is for validation purposes and should be left unchanged.