Refer a patient

A referral ensures that the patient will be assessed and treated by the appropriate specialist according to their specific needs.

The referral must provide sufficient information to accurately triage your patient and to allocate the most appropriate resources.

* Required information

Patient Details

e.g. 31/10/2017
First name and Surname
e.g. 31/10/1977

Patient Contact

e.g. 23 Main Road, Caloundra, QLD 4551
Please include area code e.g. 07 3834 4444

Medical information

Private Health Cover?

Refer to





Clinical notes

Referring doctor

Dr First name Surname
e.g. 31/10/2017
Please include area code e.g. 07 3834 4444