Referrals Referrals can be mailed, emailed or faxed to our office. Alternately, doctors and/or patients can use the following form and the patient will be contacted as soon as possible. Child Details Name DOB Parent Details Name DOB Phone Email Address Request an appointment with Please select one type of practitioner appointment per form filled Doctor ---AnyDr Yves HelouryDr Mike O’BrienProfessor John HutsonDr David Metz Physiotherapist ---AnyJanet ChaseDebbie Rechtman Request for Telehealth (See Services - Telehealth for more information) Patient history and recent investigation results Include relevant investigation results below or attach to this form, email or fax us the information. Please note there is a 2MB file upload limit. For large files, email it to us directly. Attachments: Referring Doctor Details Required for medical appointments only Doctor Type ---GPSpecialist Date Provider No. Phone Address Yes, I have a care plan from my doctor for medicare Yes, I have private health insurance Please leave this field empty.