DIGITAL REFERRAL

The COVID-19 pandemic is changing the way health services are being delivered. To support all of our referrers, Capitol Radiology is now accepting your Telehealth imaging requests via our digital referral form or template form via email. When we receive your referral we’ll call your patient to book an appointment. After the appointment, the radiologist report and images will be delivered to you through your current nominated method.

How to submit your template referral form

Using your PC or phone, complete the editable referral form provided by Capital Radiology. You can download the form below, and no signature is required.

• General referral

• Dental referral

• Chiropractic referral

• WA referral

Fax or email completed referral to our team.

Victoria – (03) 9957 0374 | WA – (08) 6154 6416

Please note

Referrals must contain:

• Full patient name

• DOB

• Address

• Phone and email details to ensure we can contact patients for bookings

• Referrer name and provider number

• Practice address

• Investigation / procedure referred

• Clinical details

If you require any assistance, please contact: victelehealth@capitalradiology.com.au