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Make an ED Referral

Step 1 of 2:

Select your preferred appointment using our calendar below. We offer appointments up to 7 days in advance.

When your appointment is confirmed, write down the appointment time and date. An email invitation will be sent directly to your patient.

Important: After you have booked your appointment, please scroll down the page to complete the referral form.

Please submit your referral information using our form below.

Referral date*
DD slash MM slash YYYY
Full name of patient being referred*
Patient's DOB*
DD slash MM slash YYYY
Patient email address*

Please enter the best email address for us to contact patient/family.
Reason for referral*
UR number*
Parent/guardian full name*
Parent/guardian contact number*
Referrer name*
Provider number*
Practice Name/Address*
Please confirm:*
- Yes, I have made a booking via the calendar above. Please take note of the booking date/time, as once you press SUBMIT appointment will be emailed to patient and no longer visible.
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Phone
This field is for validation purposes and should be left unchanged.

Main Clinic
17 Murray Street
Clayton VIC 3168

St John of God
75 Kangan Dr
Berwick VIC 3806

(03) 8572 1222
9am – 5pm
Mon – Fri