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Home
Services
Consultation & Testing
Procedures
About Us
Our Team
For Patients
Medical Glossary
Pre and Post Procedure Care
New Patient Medical Form
News
Contact Us
Refer Now
Referral
Download Referral Form
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Patient Name
*
First
Last
Postal Address
*
State
*
Postcode
*
Date of Birth
*
Contact Number
Examination Required
(ALL TESTING IS BULK BILLED)
Examination Required
ECG
EVENT MONITOR (3 Days)
EXERCISE TEST (Includes baseline ECG)
STRESS ECHO (TREADMILL) (Includes baseline ECHO)
HOLTER MONITOR
ECHO
AMBULATORY BP MONITOR (This test is not covered by Medicare)
CT Coronary Angiogram (includes Specialist review)
Telehealth Appointment
Yes
Cardiologist
Dr Michael Nguyen – Interventional Cardiologist
Dr Justin Ng – Cardiologist / Electrophysiologist
Dr Justin Teng – General and Imaging Cardiologist
Dr Bharat Khialani - Interventional Cardiologist
Clinical Details
Medical History / Medications
Specific Clinical Query
Who is Your Referring Doctor?
Name
*
Practice Name
*
Contact Number
*
Practice EDI (Health Link)
Provider No.
*
Date
Copy of report to:
Locations
Checkboxes
Nedlands
Murdoch
Mandurah
Joondalup
Albany Consulting Room
Albany Hospital
Bunbury
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