For Referring Doctors

Refer a Patient

Complete the form below and we'll contact your patient to arrange their appointment.

Appointments within 1–2 weeks Reports back to you within 48 hrs Fax: 02 8401 9599 Email: info@heartcare.sydney

Provider Referral Form

First Name

Last Name

Date of Birth

Mobile Number

Required Services:

First Consultation - New patient

Review - Existing patient

Second Opinion (Patient already seen another Cardiologist))

Echocardiogram Only - Bulk billed for eligible patients

Stress Echocardiogram Only

Clinical details:

Urgency:

Urgent

Semi-urgent (within 3 days)

Non-urgent

First Name

Last Name

Provider Number

Date

Best Contact Number

Signature

Upload Referral (optional but recommended)

Maximum file size: 5MB

If you are human, leave this field blank.