Eton Place GP Referral Form

Please provide as much information as possible to facilitate the booking process for your patient and their caregivers.

If you are referring a patient below 18 years old, we highly recommend parents/caregivers are referred as part of the child’s comprehensive initial diagnostic evaluation and ongoing treatment process.

We are subscribed to Medical-Objects. Please send your referral via Medical-Objects whenever possible.

(If you are a patient/carer, please do not complete this form by yourself. We require your GP to complete this for the referral to be valid)

Referral Details

Parent/Caregiver Details

Patient Details

Please leave blank if same as parent/caregiver address

Who do you want to book with?

Presenting Complaint and Treatment Goals

Additional Information

Please note assessments may not be covered by Medicare rebates.

General Practitioner Details

In order to receive a Medicare rebate, we require a valid GP Referral for both the patient and the parent/carer of the patient.