Referral Form

Thank you for referring to the ArthritisCARE Rheumatology team.

All referrals are initially triaged by our Rheumatologists who do their best to accommodate urgent referrals in a timely manner. On receipt of your referral via this form, we will contact your patient directly to book an appointment, and will always communicate with you soon after any consultation.

Referral to:

Reason for referral

Preferred timeframe for review

Urgent reviewNext available appointment

Patient Details:

Patient's First Name *

Patient's Surname *

Gender *

MaleFemaleNon-BinaryOther

Date of Birth *

Phone Number *

Medicare No.

Home Address (if available)

Street address

City

State

Postcode

Email for Patient (if available)

Referring Doctor Details:

Area of Practice *

General Practice SpecialistOther

Your First name *

Your Surname *

Provider No. *

Suburb in which your practice is based *

Name of your practice

Any additional information to assist with intial triage by our Rheumatologists?

Please upload any relevant documents or test results here

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Signature *

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Date *

Verification please *