Book Now
Name :
*
Email :
*
Phone :
*
Preferred Location
*
Preferred Location
No Preference
Bass Hill
Corrimal
Warrawong
Wollongong
Women's Imaging (Corrimal)
Preferred Date
*
Date Format: MM slash DD slash YYYY
Preferred Time
*
Morning
Afternoon
Type of Scan
*
Type of Scan
CT
Biopsy or Fine Needle Aspiration
Mammogram
MRI
Pain Injection
Ultrasound
Other / Unsure
Type of Scan
*
Type of Scan
CT
Biopsy or Fine Needle Aspiration
Pain Injection
Ultrasound
Other / Unsure
Referral
Drop files here or
Please upload a copy of your referral. This will ensure your appointment is booked correctly. A photo on your phone will suffice.
Comments :
(02) 8735 0400
info@basshilldx.com.au
Book Now
Home
About Us
Meet The Team
Doctors
Admin & Marketing
Latest News
Services
Digital X-Ray
Low Dose CT
Ultrasound
Spine Injections
Joint & Bursa Injections
Biopsies and Fine Needle Aspiration
ABI and PRP Injections
Patient
Translated Consent Forms
FAQ
Book An Appointment
Referrers
Download A Referral
InteleRAD
Contact Us
e Referral
Home
About Us
Meet The Team
Doctors
Admin & Marketing
Latest News
Services
Digital X-Ray
Low Dose CT
Ultrasound
Spine Injections
Joint & Bursa Injections
Biopsies and Fine Needle Aspiration
ABI and PRP Injections
Patient
Translated Consent Forms
FAQ
Book An Appointment
Referrers
Download A Referral
InteleRAD
Contact Us
e Referral
e-Referral
PHONE:
(02) 8735 0400
FAX:
(02) 8735 0499
Patient Details
First Name
*
Surname
*
Date of Birth
*
Date Format: DD dash MM dash YYYY
Address
*
Contact Number
*
Email
Medicare No.
*
Examination Required
X-RAY
CT
INTERVENTIONAL
ULTRASOUND
Clinical Notes
Region
Referring Doctor
Dr Name
*
Contact Number
Provider Number
*
Films and Report
Report
URGENT
PHONE
FAX
Films
DELIVER TO
PATIENT
MORE REQUEST PADS
CAPTCHA
