Refer a patient

You can refer your patient for a health test by submitting the following form.

We will contact your patient within 24 hours (between Monday and Friday) to arrange their appointment, and a summary report will be sent to you once they have attended.

Service

Select Preferred Test/s

Resting electrocardiogram (ECG)

Exercise electrocardiogram (ECG)

Lung function test/spirometry

Lung function test (before & after bronchodilator)

Hearing test/audiogram

Other*

*Please specify

Referrer name

First Name

Last Name

Referrer medical centre

Email address

Patient name

First Name

Last Name

Patient DOB

Patient phone number

Patient email address

Clinical details and reason for test

Current medications