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Information for Doctors
If you would like to order more referral pads please email us at
info@maxfac.com.au
Referral Form
Referring to*
Dr Edward Hsu
Dr Martin Batstone
Dr Anthony Lynham
First Available
Patient's Name *
Patient's Date of Birth *
Patient's Contact Number *
Patient X-ray *
Choose...
Patient has X-ray
X-ray will be emailed
Attach with referral
Attach Patients X-ray
The reason for the referral (what are we seeing the patient for?) *
Doctor's Name *
Doctor's Practice *
Doctor's Contact Number *
Doctor's Provider Number *
Submit