1300 788 508

Order Referrals

Online Enquiry





We can provide Referring Practitioners with a range of diagnostic imaging request formats including:

These are the traditional request form produced in pads of 50. The referring doctor details are pre printed to assist in reducing time and improving the accuracy.

The forms include information and maps with the location of Canberra Imaging Group sites and the modalities available at each site.

A4 format forms are provided which contain the same basic information as the blank request pads but are designed for use with computer systems that are capable of generating requests for medical procedures. They are available in two formats – template, or blank page.

To order referral pads, please use the form on this page or phone (02) 6203 2222.

On-line referral form

The Canberra Imaging Group has developed an ‘online referral form’ for printing referrals directly to your printer, or onto pre-printed sheets. If you are having trouble viewing this page, please download the latest version of Adobe Flash Player.

Click here to access the ‘online referral form