Referral

Doctors, please complete the following e-referral and we will be in touch with your patient to arrange their booking.

Patient Details

Patient First Name *

Patient Last Name *

Patient Date of Birth *

Patient Phone Number *

Email Address (optional)

Patient Address (optional)

Reason for Referral / Extra Clinical Information *

Additional Document Upload (optional)

Browse

Services Required

You may tick more than one service

Sleep Services

Home Sleep Test [Level 2] (Medicare / DVA Bulked Billed) *Full ReviewHome Sleep Test (Private billing) *Full ReviewInsomnia & Sleep Clinic ConsultSleep Physician Consult (via Telehealth)CPAP Trial SetupCPAP Consult (Consult / Download / Hire / Sales)

*Full Review, includes if required: Home Sleep Test, Sleep Physician consult, Spirometry, Rhinometry testing

Psychology Services

ConsultationEating Disorder Plan Therapy (*Bulked Billing Available)CBT-Insomnia Therapy (*Bulked Billing Available)

*Eligibility for Bulk Billing requires Mental Health Care plan as per MBS guidelines.

Nutritional Medicine & Naturopath Services

Consultation (Assessment and Plans)Weight ManagementTinnitus Consult & TherapyStress & Anxiety Management

Respiratory Function Testing

SpirometrySpirometry & FeNORhinometry

Service Request Notes

Referring Doctor Details

Doctor's First Name *

Doctor's Last Name *

Provider Number *

Practice Name

Practice Phone Number *

Doctor / Clinic Email *

Referral Date *

Doctor's Signature *

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For security please complete the check below *