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

    Parent Details

    Request an appointment with

    Please select one type of practitioner appointment per form filled

    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.

    Referring Doctor Details

    I am the referring Doctor

    Required for medical appointments only

    Yes, I have a care plan from my doctor for medicare

    Yes, I have private health insurance