Telehealth and e-Requests

 

Download editable PDF referral here

Please note the editable PDF referral doesn’t work correctly on mobile devices, as it uses a PDF reader only. 

Traditional referrals and/or eReferrals can be emailed or faxed to our clinics:

VIC

E: info@imagingassociates.net.au

  • Box Hill | F: 03 8843 7988
  • Mitcham | F: 03 8873 3610
  • Tecoma | F: 03 9086 7957

NSW

E: waggawagga@imagingassociates.net.au

  • Wagga Wagga | F: 02 6971 6188

E-REQUEST

This form is for referring practitioners only. You may be contacted to confirm validity
  • Patient Details

  • Referral / Request For

  • Referrer Details

  • Please include name, practice details