CALL 03 9895 0400

GP 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:

  1. Patient Details

  2. Patients First Name*
    Please enter patients first name
  3. Patients Last Name*
    Please enter patients first name
  4. Date of Birth*
    Please enter Date of Birth
  5. Address*
    Please enter your address
  6. Suburb*
    Please enter your suburb
  7. State*
    Please select state
  8. Post code*
    Please enter post code
  9. Best Patient Phone Number*
    Please enter phone number
  10. Referring Doctor Details

  11. Doctors Name*
    Please enter doctors name
  12. Address*
    Please enter doctors address
  13. Suburb*
  14. State*
    Please select state
  15. Post code*
    Please enter postcode
  16. Phone Number*
    Please enter phone number
  17. Fax Number*
    Please enter fax number
  18. Provider Number*
    Please enter provider number
  19. Other Information

  20. Clinical Problem*
    Please enter details
  21. Other relevant information
    Invalid Input
  22. Would you like us to contact the patient?*

    Please make a selection
  23. Does the patient need an audiogram (hearing test)?*

    Please make a selection
  24. Invalid Input