Online Requests

Repeat Referral Requests

For existing patients who need a repeat referral for a specialist they already attend, we offer a repeat referral request service for selected stable, ongoing concerns. All requests are reviewed by your doctor and may still require an appointment.

I am an existing patient of Rochedale Family Practice This is for a specialist, clinic, or service I have previously attended or been referred to This referral relates to an existing stable condition or ongoing review I am not requesting assessment for a new symptom, new injury, or urgent concern I understand my doctor may require an appointment before issuing a referral

Full name Please enter your full name. Date of birth Please enter your date of birth. Mobile number Please enter your mobile number. Email address Please enter a valid email address. Payment email This helps the practice match the payment hold or follow-up communication if needed. Please enter the email you will use for payment. Medicare number (optional) Specialist / clinician name This field is required. Specialty, clinic, or service This field is required. Specialist contact details (optional) Include clinic name, address, phone, fax, or email if known. Reason for referral / condition being reviewed This field is required. When were you last seen or referred for this issue? This field is required. Specialist appointment date (optional) Leave blank if not booked yet. Have your symptoms or circumstances changed? This field is required. Details of any changes (optional) Delivery preference This field is required. Additional notes (optional)

After submitting, you will be taken to Stripe to authorise the review fee. Payment is captured only after the request is carried out.

Repeat Referral Requests

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Patient and request information