PatientsReferrer
 
Request Appointment

Appointment request form 

On submitting this form please be advised that one of our receptionists will be in contact with you.

Please note that we may not be able to provide you with your exact time and date for an appointment however we will do our best to facilitate your request.

Your information is sent directly and securely to South East Radiology. We take confidentiality very seriously and it is important to note that your information is entered into our patient information system. This form is not stored.
 

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Tick multiple boxes to select more than one service.

IMPORTANT. If requesting an MRI appointment, please fill out this form instead:

Request MRI Appointment

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To ensure we have all the correct information, please upload your referral by clicking on the button below. Please note: you are required to upload all relevant documents if you have more than one referral.
Unlimited number of files can be uploaded to this field. 20 MB limit. Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.

Frequently Asked Questions

Yes, you will need a referral from your referring practitioner in order for us to provide you with imaging services.

We accept all referrals.

Our online appointment request form is available 24 hours a day. If the request is sent through outside Monday – Friday 8:00am to 5:30pm (AEST), we will contact you on the next business day.