• New patient referral & appointment request

    New Referral to see a Consultant Haematologist
  • Format: 0000 000 000.
  • Have you attended our clinic before?*

  • If your answer is YES:
    Please continue to complete this form and attach a copy of your new referral.

  • If your answer is NO:
    Please continue to complete all required fields in this form.

  • Referral information

    This is the written patient referral or letter you received from your GP or Medical Professional addressed to one of our Consultant Haematologists.
  • Do you have a copy of the patient referral you received from your your GP or Medical Specialist?*

  • If your answer is YES:

    Select the name of the Haematologist (Specialist Medical Doctor) your Referral letter is addressed to or who you wish to make a New Patient Appointment with from the drop down list shown below and then proceed to upload your Referral.

    • NOTE: If you are unsure of which specialist physician you need to make an appointment with, you can view the full list of our Haematologists available on the Melbourne Haematology website.

  • If your answer is NO:

    You MUST have an electronic COPY of your referral letter received from your GP or Medical Specialist in order to request a New Patient Appointment with one of Haematologists.

    You will need to make a copy of this letter to send to us in order to proceed and complete this form.

    Use your smart phone to take a photo (or scan) of the document that you can then upload.

    If you do not yet have a referral, please make an appointment to see your GP or Medical Specialist and request a new referral to see one of our Haematologists.

  • Our Haematologists

    Who do wish to request an appointment with?
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