Make a Referral

Referring a patient is easy

We can contact the patient to arrange the appointment if you like.

It is important that patients with ear and hearing complaints have a hearing test prior to their appointment.

We are happy to help arrange these.

All referrals are treated confidentially according to Privacy Law. Our Privacy Policy is here.

Option 1

Print, complete and fax the following form to (03) 9895 0444.

Option 2

Complete the online referral form below:

Patient Details

Patients First Name*

Please enter patients first name

Date of Birth*

Please enter Date of Birth

Patients Last Name*

Please enter patients first name

Address*

Please enter your address

State*

Please select state

Best Patient Phone Number*

Please enter phone number

Suburb*

Please enter your suburb

Post code*

Please enter post code

Referring Doctor Details

Doctors Name*

Please enter doctors name

Address*

Please enter doctors address

Suburb*

State*

Please select state

Post code*

Please enter postcode

Phone Number*

Please enter phone number

Provider Number*

Please enter provider number

Fax Number*

Please enter fax number

Other Information

Clinical Problem*

Please enter details

Other relevant information

Invalid Input

Would you like us to contact the patient?*

Yes - please arrange an appointment with the patient

No - the patient will make contact with ENTV

Please make a selection

Does the patient need an audiogram (hearing test)?*

No - they don't need one or have had one recently

Yes - please arrange one before their appointment

Please make a selection

Invalid Input

Make an appointment today

Please contact us via Head Office (03) 9895 0400 for any questions or to book a prompt appointment.

FRACS ASOHNS AHPRA

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