We can provide Referring Practitioners with a range of diagnostic imaging request pad formats. Please use the form below to order referral pads online or phone (02) 6203 2222.

Type: Count Per Pack Type: Count Per Pack
A5 Personalised – GP 50 A4 Detailed 100
 Image of A5 Personalised referral  Image of A4 Detailed referral
A5 Personalised – Non GP 50 A4 PET 100
 Image of A5 Personalised NON GP referral Image of A4 PET referral
A5 Blank – GP 50 A4 PET Personalised 50
 Image of A5 Blank GP referral  Image of A4 PET Personalised referral
A5 Blank – Non GP 50 A5 Blank – Hospital 50
 Image of A5 Blank NON GP referral Image of A5 Blank Hospital referral

Referral Pad Order

To order referral pads over the phone, please phone (02) 6203 2222, or fill in the details below:
Referring Practitioner Address including Practice Name/Department
Confirmation will be sent here
Please provide any special delivery instructions to ensure your order arrives. (building number, floor level, attention to)
Select Referral Request Type
Number of packs required