Order Referral Pads/Paper

Introduction

Complete this online form to order your Referral Paper or Referral Pads

  • Phone Number to be printed on Referral
  • Fax Number to be printed on Referral
  • Order Computer Paper

  • Ream of Computer Paper Referrals
  • Please enter a value greater than or equal to 0.
  • Order Referral Pads

  • Check type name of your existing stock in the vertical blue ribbon on the far right
  • Please enter a value greater than or equal to 0.
  • MRI or PET/CT
  • Please enter a value greater than or equal to 0.
  • Have a query on what to order? Email: referrals@perthradclinic.com.au

    Please enter the word you see in the image below into the text box underneath.
    (Please note: case sensitive)