Online Referral

Fill the online form below to refer your patient via our website. A copy of this form will be sent to our practice, as well as the email address you specify. 

Our team will be in contact with the patient within 2-3 days of receiving the referral. For urgent cases, please contact us by phone on 07 5616 6008.

Printed Referral

Click on the link to download a PDF copy of our referral form. Referrals can be submitted by fax, healthlink, or Oculo. The original should be given to the patient.

Patient Details

Patient Name(Required)
DD slash MM slash YYYY

Referral Details

DD slash MM slash YYYY
Reason for Referral(Required)

Referrer Information

Referred By:(Required)
A copy of this referral will be sent to this address.
Practice Address
Drop files here or
Accepted file types: pdf, jpg, png, doc, docx, xls, xlsx, Max. file size: 1 MB, Max. files: 4.
    Please upload any other relevant information to accompany this referral
    This field is for validation purposes and should be left unchanged.

    Scroll to Top