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Home
About
Cardiologists
Services
Diagnostic Testing
Procedures
Conditions We Treat
Patient Info.
GP Referrals
Locations
News
Contact
Online Referral
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Appointment Date:
*
Name:
*
Gender:
Male
Female
Others
Medicare No.
*
Referring Doctor’s Details:
*
Provider No.
*
Clinical details:
*
Doctors signature:
*
Click or drag a file to this area to upload.
Investigation requested
*
Consultation with 12 Lead ECG
URGENT (Same Day) Consult ** (Telephonic Advice)
Echocardiogram
Stress Echocardiogram ** (with Pre-assessment)
24hr Blood Pressure Monitor ** (charges apply)
24hr Holter Monitor/ Heart Event Monitoring
Treadmill Exercise Stress ECG ** (with Pre-assessment)
Pacemaker Check / Device Check
Appointment Time:
*
DOB:
*
Phone / Mobile:
*
Copies to:
*
Address:
*
Reports to be:
*
Posted
Faxed
Emailed
Details:
*
Date
*
Consultation requested with
*
Dr Rajesh Brahmbhatt
Dr Louis Wang
Dr Ata Rehman
Dr Inaam Ullah
Dr Shweta Sahay
Dr Xavier Brennan
Dr Ata Doost
Dr Hany Abed
FIRST AVAILABLE CARDIOLOGIST
Preferred location
*
Hurstville
Suite 10, Level 2, 33 MacMahon Street Hurstville NSW 2220
Phone: 02 9570 5666
Fax: 02 9570 5644
Wetherill Park
5A Price Street Wetherill Park
NSW 2164
Phone: 02 8798 7001
Fax: 02 8798 2253
Wentworthville
20A Station Street Wentworthville
NSW 2145
Phone: 02 9761 9288
Fax: 02 9761 9290
Submit Details Now
Please enable JavaScript in your browser to complete this form.
Appointment Date:
*
Appointment Time:
*
Name:
*
DOB:
*
Gender:
Male
Female
Others
Phone / Mobile:
*
Medicare No.
*
Copies to:
*
Referring Doctor’s Details:
*
Address:
*
Provider No.
*
Reports to be:
*
Posted
Faxed
Emailed
Clinical details:
*
Details:
*
Doctors signature:
*
Click or drag a file to this area to upload.
Date
*
Investigation requested
*
Consultation with 12 Lead ECG
URGENT (Same Day) Consult ** (Telephonic Advice)
Echocardiogram
Stress Echocardiogram ** (with Pre-assessment)
24hr Blood Pressure Monitor ** (charges apply)
24hr Holter Monitor/ Heart Event Monitoring
Treadmill Exercise Stress ECG ** (with Pre-assessment)
Pacemaker Check / Device Check
Consultation requested with
*
Dr Rajesh Brahmbhatt
Dr Louis Wang
Dr Ata Rehman
Dr Inaam Ullah
Dr Shweta Sahay
Dr Xavier Brennan
Dr Ata Doost
Dr Hany Abed
FIRST AVAILABLE CARDIOLOGIST
Preferred location
*
Hurstville
Suite 10, Level 2, 33 MacMahon Street Hurstville NSW 2220
Phone: 02 9570 5666
Fax: 02 9570 5644
Wetherill Park
5A Price Street Wetherill Park
NSW 2164
Phone: 02 8798 7001
Fax: 02 8798 2253
Wentworthville
20A Station Street Wentworthville
NSW 2145
Phone: 02 9761 9288
Fax: 02 9761 9290
Submit Details Now
