Referrals

You must have a valid referral from your GP or specialist if you wish to claim the Medicare rebate from your payment.

A valid referral can be for 12 months from your General Practitioner or 3 months from your specialist. If you have no valid referral you will be liable for the entire payment of services. Invalid referrals cannot be modified after the appointment at our rooms.

A valid referral will contain:

Name of doctor you wish to consult, with the requested service.
Requests for tests addressed to a specific doctor or an unspecific doctor.
Name, Provider number and address of the referring practitioner is mandatory.
The referral must be signed and dated.
The above also applies to public hospital doctors referring patients for inpatient and outpatient care.

If you have a referral from your GP to consult one of our specialists or take a test please fill in your information below, scan and upload your form below.

Referral Form

All fields marked * are required.

Patient details
Name*
Email*
Phone (Home)*
Mobile*
Date of Birth*
Address*
Street Address Address Line 2 City State Post Code
Doctor details
Referring Doctor*
Referrer Phone Number*
- Please phone me to discuss this case
Treatment details
Treatment Request
Attach your patient xrays, images, and reference material files here
File 1
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 2
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 3
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 4
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 5
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 6
Accepted file types: jpg, gif, png, pdf, doc, docx.
Name
This field is for validation purposes and should be left unchanged.

Exceptional Heart Care

Referrals

Referral Form

Patient details

Doctor details

Treatment details

Attach your patient xrays, images, and reference material files here

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