Perth Radiological Clinic

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Order Referral Pads/Paper

Introduction

Complete this online form to order your referral paper or referral pads.

Should you need referral paper or pads urgently, please email sales@perthradclinic.com.au

Name of person ordering*
Email address*
Name of surgery*

For delivery of referral pads/paper
Surgery phone number*
Delivery address*
Order Referral Paper
Referral paper
Used with practice management software
Number of Reams
Please enter a number greater than or equal to 0.
250 sheets per ream
Order Referral Pads
Standard pads
Handwritten by referrer
No. of standard pads
Please enter a number greater than or equal to 0.
50 sheets per pad
Allied Health
Handwritten by referrer
No. of allied health pads
Please enter a number greater than or equal to 0.
50 sheets per pad
MRI
Handwritten by referrer
No. of MRI pads
Please enter a number greater than or equal to 0.
50 sheets per pad
Other specialised referrals
Handwritten by referrer
No. of other specialised pads
Please enter a number greater than or equal to 0.
50 sheets per pad
Details to be printed on referral pads
Phone Number
Phone Number to be printed on pads
Fax Number
Fax Number to be printed on pads
Address
Address to be printed on pads
Referrers to be printed
Referrer name Provider number

Please include all names and provider numbers to be printed on pads and format, e.g. Dr A. Doctor; Dr Angus Doctor; etc. Press + to add more.
Any special instructions?
Have a query on what to order? Email: referrals@perthradclinic.com.au

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Perth Radiological Clinic

Perth Radiological Clinic is a leader in providing medical imaging services throughout the Perth area. We are committed to providing our patients and referring doctors with the highest standard of diagnostic medical imaging.

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