How you can get your referral to us

• Email to refer@perthradclinic.com.au
• Submit online
• Fax to 9286 0403
  

Which referral to use?

1. 1. 1. 1. You can use your usual practice software generated referral form
         2. Download our editable PDF standard referral form
         3. If you do not have access to a referral form, complete our online e-Referral
         4. A hand written (free text) request on plain or headed paper is acceptable

      Free text referrals will be accepted and must contain:

      1. 1. • patient full name
            • DOB
            • address
            • mobile and email (so we can contact them)
            • referrer name
            • provider number
            • practice name
            • practice address
            • investigation requested
            • clinical details
            • preferred method of contact (email or mobile so we can contact you if needed)
            • referrer’s signature not required

      Please call ahead to 1300 567 046 on behalf of your patient if your request is clinically urgent.

      If you need assistance, please contact your Customer Relations Manager

      Complete online e-Referral or submit printed referral online

      e-referral

      • Complete online e-Referral or submit printed referral
        Online e-ReferralUpload Referral

      • Referring Doctor Details

      • Dr. Name*
      • Practice
      • Dr. Provider Number*
      • Dr. Email*
        Email used for confirmation to referring doctor.
      • Contact Number*
      • File*
        Max. file size: 8 MB.
      • CC Instructions

      • Patient Details

      • Title
        MrMrsMissMsDrProf
      • First Name*
      • Last Name*
      • Date of Birth*
        Day12345678910111213141516171819202122232425262728293031

        Month123456789101112

        Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
      • Patient Phone Number*
      • Patient Email
        Enter Email Confirm Email
        Email is used for appointment confirmation
      • Procedure required*
        Select a ProcedureCTMRINuclear MedicineUltra SoundX-raysOther
      • Examination Request*
      • Clinical History
      • Please enter the word you see in the image below into the following text box.
        (Please Note: Case Sensitive)
      • Captcha