Referrals – To be completed by doctors only


This is our online referral form. Once you have completed all the details and attached any relevant documentation, you can save this form to your computer and to your patient’s file. Once you submit, you will be informed that we have received the referral. Thank You.

We will contact your patient to organise an appointment at a time and location most convenient for them.

GP Referral Request


Referral To *

Patient Information

Referring Doctor Details


Clinical Details

Urgent Requests
Additional Documents
Maximum upload size: 10MB

Important Notice


We want to assure you that we are staying up to date with the COVID-19 situation. 
We are now offering phone consultations, and in some cases, Telehealth consultations for both new and existing patients.

We are working together with the private hospitals to ensure the utmost safety and protection for our patients during endoscopy procedures.

If you are concerned about whether you have symptoms similar to coronavirus, or may have been exposed to coronavirus, and have a consultation or procedure booked with us, please contact our rooms on 03 9468 9700. We will discuss the best course of action with you. 
Thank you.