Referrers

All referrals will be triaged by a clinician, and if deemed inappropriate for Telehealth, and not possible for patient to travel to our clinic to be seen in person, we may ask the referring doctor to refer the patient to nearest appropriate neurology or epilepsy clinic.

You can send referrals to [email protected] or use one of the options below.

Medical Practitioners

Alternatively, you can fill in the form below and it will be sent to us as a referral

Referral date

Patient's First Name(Required)

Patient's Surname(Required)

Patient's D.O.B(Required)

Patient's best contact number(Required)

Patient's email address

Referring doctor's name(Required)

Referrer Provider number(Required)

Referrer practice name(Required)

Please describe the reason/s for referral(Required)

Include as much detail as possible. Please include past medical history, medications and any relevant investigations

Patient Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

This field is for validation purposes and should be left unchanged.

Patients/Carers

If you are patient or carer and have a referral already from your doctor, you can upload the referral using the link below.