Online Referral Form

We have cardiologists available on site 5 days a week. If you have a patient who needs to be seen urgently, don’t hesitate to call up any of our rooms and speak to somebody. We will do our best to accommodate your request and provide you with advice over the phone.

IMPORTANT! You must be a Registered Medical Practitioner to use this referral form. If you are a patient that requires a referral to one of our doctors, please speak with your GP.

Patient Details

Referral To

Referral For

Echocardiogram Criteria
Stress Echocardiogram Criteria
Stress Test (ECG) Criteria
Holter Monitor Criteria
Extended Holter Duration
24-Hour BP Monitor Criteria
12 lead ECG request
Patient's device type
Patient's device Brand

REFERRING DOCTOR DETAILS

GENERAL ENQUIRIES

Liverpool

  • 02 9600 6366
  • Suite 14 Fax: 02 8322 8091
  • Suite 25 Fax: 02 8322 8030
  • Suite 14 & 25 17 Moore Street Liverpool NSW 2170

Camden

  • 02 4655 4099
  • FAX:02 8322 8093
  • 72 John Street Camden NSW 2570

Campbelltown

  • 02 4628 1433
  • Fax: 02 8322 8092
  • Suite 1, Specialist Medical Centre cnr King & Queen Streets Campbelltown NSW 2560