GP & Specialist Referral

This is an online referral form for GPs and Specialists. 

If you prefer to do a paper based referral, please fill out a referral letter or download our priority pain referral form and fax to us on 1300 798 385.  

If you are a patient seeking a referral, please call us directly on 1300 798 682 or fill out our online contact us form

Patient Details
Date of Birth *
Date of Birth
Patient's Medical History
Pain *
What type of pain is the patient experiencing?
Referral Information *
Which services are required?
Please include information about any relevant correspondence, medical and x-ray/scan reports and past treatments.
Referring Practitioner Details