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Referral CardiologyAPPT DATE/TIME
PATIENT NAME DATE OF BIRTH
ADDRESS PHONE & EMAIL
[email protected] | genesiscare.com
INVESTIGATIONS REQUESTED
● 1. Echocardiogram
● 2. Stress echo
● 3. Resting ECG
● 4. Exercise stress test
● 5. Holter monitor (24 hour)
● 6. Patient activated event monitor (7 day event monitor)
● 7. Ambulatory BP monitor (not covered by Medicare)
● 8. Dobutamine stress echo
● 9. Transoesophageal echo
● 10. Ankle brachial index
● 11. Consultation only
● 12. Heart failure management clinic
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SIGNATURE/DATEREFERRING DOCTOR COPY TO
Your doctor has recommended that you use GenesisCare for your test. Should you wish to use another provider, please discuss this with your doctor first.
To prepare for your test, please visit genesiscare.com/cardiology
Formerly:
CLINICAL DETAILS
Please print, sign and date
Cardiologists Centre Locations
● Dr Deepak Arumugam
● Dr Tau Boga
● Dr Michelle Butler
● A/Prof Peter Cain
● Dr Anthony Camuglia
● Dr Gerard Connors
● Dr Stephen Cox
● Dr David Cross
● Dr Robert Fathi
● Dr Ben Fitzgerald
● Dr Terri Hall
● Dr Sam Hayman
● Dr Geoffrey Holt
● Dr Julie Humphries
● Dr Peter Moore
● Dr Stephen Pavia
● Dr Karen Phillips
● Dr Tony Rafter
● Dr Andrew Rainbird
● Prof Gregory Scalia
● Dr Anders Taylor
● Dr Angus Thompson
BUNDABERG
● Dr Andre Conradie
● Dr David Di Fiore
● Dr David Grout
● Dr Hermann Wittmer
BOOKINGS FOR METRO SITES: (07) 3858 8690
● ClayfieldOriel Place, Suite 3, Level 1531 Sandgate RoadT 3648 2500 | F 3648 2510
● Greenslopes Private Hospital
Suite 212, Level 2Ramsay Specialist CentreNewdegate StreetT 3255 7200 | F 3255 7290
● Mater Private ClinicSuites 5.02 & 5.11, Level 5550 Stanley StreetSouth Brisbane T 3360 7100 | F 3360 7109
● Mount OmmaneyMedical Centre, Shop 6171 Dandenong RoadT 3725 3900 | F 3725 3910
● The Wesley Hospital(Consulting) Sandford Jackson BuildingLevel 5, Suite 91, 30 Chasely Street, AuchenflowerT 3858 8600 | F 3858 8610
● The Wesley Hospital(Testing) Level 2, Corner Coronation Drive & Chasely Street Auchenflower T 3858 8650 | F 3858 8910
● Westside Private HospitalSuite 309, Level 3 32 Morrow Street TaringaT 3022 7850 | F 3022 7860
BOOKINGS FOR REGIONAL SITES VIA NUMBERS BELOW
● BundabergFriendly Society PrivateHospital, Floor 1, 19-23 Bingera StreetT 4199 7300 | F 4199 7319
● Bundaberg WestBundaberg Base HospitalCardiac Investigations UnitBourbong StreetT 4199 7000 | F 4199 7010
● Hervey BayUrraween Medical Centre Suite 4, 156 Urraween RoadUrraweenT 4303 4300 | F 4303 4310
● Sunshine CoastSunshine Coast UniversityPrivate Hospital, Suites 14 & 153 Doherty Street, BirtinyaT 5390 3700 | F 5390 3799
BOOKINGS FOR VISITING CLINICS: (07) 3858 8690
● Beaudesert
● Capalaba
● Emerald
● Gladstone
● Gympie
● Jimboomba
● Kingaroy
● Maryborough
● Rockhampton
● Roma
● Springfield
● Toowoomba
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Formerly: [email protected] | genesiscare.com
