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
A5 Personalised – Non GP 50 A4 PET 100
A5 Blank – GP 50 A4 PET Personalised 50
A5 Blank – Non GP 50 A5 Blank – Hospital 50

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
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