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COVID-19: Find out about our screening clinic - and note our current visitor restrictions

We have a wide range of clinical resources available to our health professional community, including referral forms and referral guidelines.

Resource Title Type
Acquired Brain Injury (ABI) Rehabilitation referral form (pdf 549 KB) Referral form
Acquired Brain Injury Community Rehabilitation Referral Form (pdf 114 KB) Referral form
Allergy, Asthma & Clinical Immunology Referral Form (pdf 313 KB) Referral form
Anorectal Physiology request form (pdf 276 KB) Referral form
Better at Home - referral form (pdf 203 KB) Referral form
Catheter Lab referral form (pdf 150 KB) Referral form
CH PCS Referral Form (pdf 28 KB) Referral form
Child and Youth Mental Health Service (CYMHS) referral form (pdf 366 KB) Referral form
Diabetes Clinic referral form (pdf 234 KB) Referral form
EEG/EMG referral form (pdf 36 KB) Referral form
Fibroscan referral form (pdf 263 KB) Referral form
Gastrointestinal endoscopy referral form (pdf 119 KB) Referral form
Health Assessment Questionnaire - CCHS (pdf 67 KB) Referral form
Heart Centre referral form (pdf 182 KB)

For clinical assessment and cardiovascular investigations

Referral form
HIV Complex Metabolic Clinic referral form (pdf 108 KB) Referral form
HIV Sub Acute Services referral form (pdf 87 KB) Referral form
ICU referral form (pdf 315 KB) Referral form
Insulin Initiation Medication Referral form (pdf 516 KB)

For practitioners to complete

Referral form
Intestinal Ultrasound referral form (pdf 161 KB) Referral form
MRI Cardiac Referral form (pdf 57 KB) Referral form
MRI Prostate Scan Referral Form (pdf 58 KB) Referral form
Nuclear Med SPECT & PET cognitive decline referral form (pdf 103 KB) Referral form
Ophthalmology outpatient referral form (pdf 107 KB) Referral form
Outpatient referral form (pdf 229 KB) Referral form
PEG Clinic referral form (pdf 45 KB) Referral form
Post Acute Care referral form (pdf 182 KB) Referral form
Referral for Clozapine Management (pdf 167 KB) Referral form
Referral to Lung Function Laboratory (pdf 263 KB) Referral form
Referral to Victorian Melanoma Service (pdf 220 KB) Referral form
Sandringham Arrhythmia Clinic - Referral form (pdf 184 KB) Referral form
Specialist Consulting Clinics Referral Form (pdf 229 KB) Referral form
Sub acute services referral form (pdf 97 KB) Referral form
Uterine Fibroid Embolisation Service Referral Form (pdf 131 KB)

Use this form to refer for consultation and if appropriate, perform a fibroid embolisation procedure.

Referral form
Vascular investigations referral form (pdf 48 KB) Referral form
VEM admission referral form (pdf 287 KB) Referral form
Victorian HIV Mental Health Service (VHMHS) referral form (pdf 63 KB) Referral form
Video urodynamics referral form (pdf 66 KB) Referral form