Refer a Patient | South Australian Medical Specialists

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Refer a Patient
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Home
About
- Work with us
Services
Locations
Our Team
Insights
Patient Info Hub
Refer a Patient
Contact Us

Refer a patient

Home
About
- Work with us
Services
Locations
Our Team
Insights
Patient Info Hub
Refer a Patient
Contact Us

×

Home
About
- Work with us
Services
Locations
Our Team
Insights
Patient Info Hub
Refer a Patient
Contact Us

Refer a patient.

Please fill in all the details below to refer a patient to us.

Patient's Full Name *

Referrer's Full Name *

HTML

Names cannot match!

Type of Referral: *Urgent ReferralRoutine ReferralPFT Only

Patient Details

Patients Full Name *

Contact Number *

Date of Birth *

Medicare Number

Sex at Birth *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Requested Investigations

Please select an option *Complex lung function assessment [Spirometry (pre and post), Lung Volumes, DLCO (Hb cor)]Spirometry (pre and post)Six minute walk test

Relevant Clinical Details (including bronchodilator therapy):

Please specify any relevant clinical details *

Referring MO Details:

Provider number *

Extra copies to

Digital Signature *

Date *

Please upload referral letter: *Please Note: Referral Letter must be signed.

No file chosen

Please do not fill in this field.

Two South Australian Medical Specialist team members looking at patient data.

Refer a patient.

Please fill in all the details below to refer a patient to us.

Patient's Full Name *

Referrer's Full Name *

HTML

Names cannot match!

Type of Referral: *Urgent ReferralRoutine ReferralPFT Only

Patient Details

Patients Full Name *

Contact Number *

Date of Birth *

Medicare Number

Sex at Birth *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Requested Investigations

Please select an option *Complex lung function assessment [Spirometry (pre and post), Lung Volumes, DLCO (Hb cor)]Spirometry (pre and post)Six minute walk test

Relevant Clinical Details (including bronchodilator therapy):

Please specify any relevant clinical details *

Referring MO Details:

Provider number *

Extra copies to

Digital Signature *

Date *

Please upload referral letter: *Please Note: Referral Letter must be signed.

No file chosen

Please do not fill in this field. Please do not fill in this field.

Two South Australian Medical Specialist team members looking at patient data.

Refer a patient.

Please fill in all the details below to refer a patient to us.

Patient's Full Name *

Referrer's Full Name *

HTML

Names cannot match!

Type of Referral: *Urgent ReferralRoutine ReferralPFT Only

Patient Details

Patients Full Name *

Contact Number *

Date of Birth *

Medicare Number

Sex at Birth *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Requested Investigations

Please select an option *Complex lung function assessment [Spirometry (pre and post), Lung Volumes, DLCO (Hb cor)]Spirometry (pre and post)Six minute walk test

Relevant Clinical Details (including bronchodilator therapy):

Please specify any relevant clinical details *

Referring MO Details:

Provider number *

Extra copies to

Digital Signature *

Date *

Please upload referral letter: *Please Note: Referral Letter must be signed.

No file chosen

Please do not fill in this field. Please do not fill in this field. Please do not fill in this field.

Refer a patient.

Please fill in all the details below to refer a patient to us.

Patient's Full Name *

Referrer's Full Name *

HTML

Names cannot match!

Type of Referral: *Urgent ReferralRoutine ReferralPFT Only

Patient Details

Patients Full Name *

Contact Number *

Date of Birth *

Medicare Number

Sex at Birth *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Requested Investigations

Please select an option *Complex lung function assessment [Spirometry (pre and post), Lung Volumes, DLCO (Hb cor)]Spirometry (pre and post)Six minute walk test

Relevant Clinical Details (including bronchodilator therapy):

Please specify any relevant clinical details *

Referring MO Details:

Provider number *

Extra copies to

Digital Signature *

Date *

Please upload referral letter: *Please Note: Referral Letter must be signed.

No file chosen

Please do not fill in this field. Please do not fill in this field. Please do not fill in this field. Please do not fill in this field.

Two South Australian Medical Specialist team members looking at patient data.

Simple referrals and easy access to specialist care

Referring a patient is simple and secure. Our team ensures a smooth process from referral to appointment.

Refer a patient

Referring a patient is simple and secure. Our team ensures a smooth process from referral to appointment.

Patient's Full Name *

Referrer's Full Name *

HTML

Names cannot match!

Type of Referral: *Urgent ReferralRoutine ReferralPFT Only

Patient Details

Patients Full Name *

Contact Number *

Date of Birth *

Medicare Number

Sex at Birth *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Requested Investigations

Please select an option *Complex lung function assessment [Spirometry (pre and post), Lung Volumes, DLCO (Hb cor)]Spirometry (pre and post)Six minute walk test

Relevant Clinical Details (including bronchodilator therapy):

Please specify any relevant clinical details *

Referring MO Details:

Provider number *

Extra copies to

Digital Signature *

Date *

Please upload referral letter: *Please Note: Referral Letter must be signed.

No file chosen

Please do not fill in this field. Please do not fill in this field. Please do not fill in this field. Please do not fill in this field. Please do not fill in this field.

Contact Us

Ready to take the next step in your care? Fill out the form below to request a consultation, and our team wil be in touch.

Full Name *

Phone *

Email *

Comment *

Please do not fill in this field.

South Australian Medical Specialists is a group of specialist doctors providing coordinated, patient-focused care across Adelaide and South Australia.

Visit SAMS on Facebook & LinkedIn.

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Quick Links

Home
Services
About
Locations
Contact

Resources

Refer a Patient
Lung Function Test Referral
Sleep Study Referral
Meet the Team
Patient Info Hub

Information

Contact:
Phone: 08 8298 9025
Email: admin@samedicalspecialists.com.au

Address:
379 Brighton Road,
Hove SA 5048.

South Austrailian Medical Specialists Pty Ltd | AB 86 483 590 578 and ACN 147 589 578

South Australian Medical Specialists (SAMS) is committed to ensuring our website is accessible and inclusive for all users, including people with disability.

We aim to meet the Web Content Accessibility Guidelines (WCAG) 2.2 Level AA standards and to provide a website that is usable across a wide range of devices and assistive technologies.

If you experience difficulty accessing any information on this website, require content in an alternative format, or need assistance, please contact our team:

Phone: 08 8298 9025
Email: admin@samedicalspecialists.com.au

We welcome feedback and are continually working to improve accessibility across our services.

© South Australian Medical Specialists
Built by Apiro

South Australian Medical Specialists is a group of specialist doctors providing coordinated, patient-focused care across Adelaide and South Australia.

Visit SAMS on Facebook & LinkedIn.

Facebook-f Linkedin-in

Information

Contact:
Phone: 08 8298 9025
Email: admin@samedicalspecialists.com.au

Address:
379 Brighton Road,
Hove SA 5048.

Quick Links

Home
Services
About
Locations
Contact

Resources

Refer a Patient
Lung Function Test Referral
Sleep Study Referral
Meet the Team
Patient Info Hub

South Austrailian Medical Specialists Pty Ltd | AB 86 483 590 578 and ACN 147 589 578

South Australian Medical Specialists (SAMS) is committed to ensuring our website is accessible and inclusive for all users, including people with disability.

We aim to meet the Web Content Accessibility Guidelines (WCAG) 2.2 Level AA standards and to provide a website that is usable across a wide range of devices and assistive technologies.

If you experience difficulty accessing any information on this website, require content in an alternative format, or need assistance, please contact our team:

Phone: 08 8298 9025
Email: admin@samedicalspecialists.com.au

We welcome feedback and are continually working to improve accessibility across our services.

© South Australian Medical Specialists
Built by Apiro