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Change Specialist – Referral Letter
Step 1 of 2
50%
First we need to ask you some questions.
I confirm I have a GP and will enter their details below
*
Yes
No
I confirm that I already have a specialist referral letter that is less than 12 months old, but I now wish to attend a different specialist for the same health issue described in the original letter.
*
Yes
No
Please enter your new specialist's details
Specialist’s Name
*
Choose type of specialist
*
Choose a Specialist
Aged Care Physician
Allergy Specialist
Anaesthetist
Bariatric Surgeon
Breast Surgeon
Cardiologist
Cardiothoracic Surgeon
Colorectal Surgeon
Dermatologist
ENT Surgeon
Endocrine Surgeon
Endocrinologist
Endoscopist
Fertility Specialist
Gastroenterologist
General Physician
General Surgeon
Genetics Specialist
Geriatrician
Gynaecologist
Haematologist
Hand Surgeon
Hepatobiliary Surgeon
Hepatologist
Immunologist
Infectious Diseases Specialist
Lymphoedema Specialist
Maxillofacial Surgeon
Medical Oncologist
Neonatologist
Nephrologist
Neurologist
Neurosurgeon
Obstetrician
Obstetrician & Gynaecologist
Occupational Medicine
Oncologist
Ophthalmologist
Optometrist
Oral Surgeon
Orthopaedic Surgeon
Otorhinolaryngologist
Paediatrician
Pain Medicine
Palliative Care
Pharmacologist
Physician
Plastic Surgeon
Psychiatrist
Radiation Oncologist
Rehabilitation Medicine
Renal Specialist
Respiratory Specialist
Rheumatologist
Sexual Health Physician
Sleep Physician
Sports Medicine
Surgeon
Travel Medicine
Urogynaecologist
Urologist
Vascular Surgeon
Specialist’s Address
*
Specialist’s Postcode
*
Specialist’s Phone Number
*
Specialist’s Fax Number
Please enter your GP's details
GP’s Name
*
GP’s Address
*
GP’s Postcode
*
GP’s Phone Number
*
GP’s Fax Number
Please add the condition(s) or health problem(s) for which you attend this specialist
Special Notes
To complete your change specialist referral letter , we need to obtain your medical history
Please select any conditions from the following list that apply to you now, or have applied to you in the past (leave blank if none apply)
Hypertension ( high blood pressure)
Heart disease
Stroke
Asthma
Thyroid disorder
Type 1 Diabetes
Type 2 Diabetes
Anxiety/depression
Epilepsy
Liver disease
Migraine (diagnosed by a doctor)
Cancer
Blood clots
Arthritis
Smoker
Other
We also need to know about any surgical history. Have you had any surgery in the past?
*
Yes
No
Please select any of the following that apply to you:
Appendicectomy
Heart Surgery
Bowel Surgery
Tonsillectomy
Gynaecological surgery
Weight loss surgery
Gallbladder surgery
Prostate surgery
Other
Have you had any allergies or bad reactions to any of the following medications?
Penicillins
Sulpha drugs
Antibiotics other than penicillin/sulpha drugs
Anti-inflammatories
Codeine
Morphine or morphine related medications
Other
I agree to provide an up-to-date list of all my medications to my specialist when I attend for my appointment
*
Yes
No
I accept that if I do not bring the original referral to the appointment, this new referral will be invalid
*
Yes
No
Do all the following apply to you? (please read carefully before confirming)
*
○ I am 18 years old or over, and currently in Australia.
○ This referral is for my own personal use only.
○ I understand that I am responsible for advising my specialist, and any other healthcare professional(s) I attend, of relevant information relating to my health and any changes in my health.
○ I understand that there may be a waiting list to see a specialist- if my condition gets worse in the interim I will seek medical attention.
○ I am aware there may be out of pocket costs for attending a specialist, which I will discuss with them.
○ I agree to the terms and conditions of use.
Yes, I confirm all the above
No
Thank you for completing this questionnaire- please click NEXT below to continue your booking
Please select a Video consultation or Phone Consultation
*
Phone Consultation
Video consultation
Please enter your Phone number
*
Confirm your phone number
*
Please complete payment and then choose your appointment time.
The following times are available to book a consultation.
Please complete the following steps:
Purchase the consultation from the shopping cart
Select and confirm your telehealth consultation time
Click on the sms or email link 15 minutes prior to the start of your consultation time
The doctor will call you on the video link during your chosen time slot
Next
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