Letter / referral requests.
Please complete this form for request of letters (e.g. school) or referrals (e.g. psychology, specialists.)There will be a $30 fee for using this service. This form can only be utilised if you have seen a paediatrician in the last 12 months and you have already scheduled a follow up appointment. By using this service you consent, if required, to a bulk billed video consult to clarify any details. Response time will vary from 24hrs to up to two weeks. You will be notified if an additional in rooms or Telehealth appointment is required.
Child's Name
First Name
Last Name
Child's date of birth
Parent's name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Paediatrician
Concern
referral
letter
Comments & Requests
0/50
Submit
Should be Empty: