SNSW - GP Colleague Referral Provider Form
Complete this form to identify the procedures or areas of special interest that you would accept one-off GP Colleague Referrals for. Note: this information will be displayed on the ACT & Southern NSW HealthPathways GP Colleague Referrals page.
Name
*
First Name
Last Name
Email
*
example@example.com
Secure Messaging address (for referrals)
e.g Argus or HealthLink address
Practice name
*
Check each of the procedures or areas of special interests below that you would accept a one-off GP Colleague Referral for.
*
Procedure or area of special interest
List relevant qualifications (optional)
Antenatal Care, Obstetrics, and Gynaecology
Aviation Medicals
Breastfeeding Support
Carpal Tunnel Surgery
Chronic Pain Management
Circumcision - Male
Contraception - Implant Insertion or Removal
Contraception - Intrauterine Device (IUD)
Cosmetic Procedures
Dermatology
Diving Medical Assessment
Drug and Alcohol Dependence
Ear, Nose and Throat (ENT)
Fracture Management
Human Immunodeficiency Virus (HIV) - Specialist Prescriber (s100)
Hypnosis
Immunology and Allergy Assessment
Ingrown Toenail Surgery
Intravenous (IV) Iron Infusion
Musculoskeletal Injections
Obesity, Diabetes and Lifestyle Interventions
Paediatric Care
Palliative and End of Life Care
Pre-employment Medical
Ring Pessary Fit or Change
Skin Cancer Excision
Specialised Prescribing - Hepatitis B
Sports Medicine Assessment
Termination of Pregnancy
Tongue-tie (Anklyoglossia)
Transgender Health
Vasectomy
Women's Health
Please use the space below to identify other procedures or areas of special interest that are not listed above (optional).
List other procedure or area of special interest
Other
Optional: Practice Name (if you work in a second practice location please indicate here. Note: if you will not accept one-off colleague referrals for all the procedures or interests ticked above in both practices please complete a separate form for each practice).
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