Referral Form

Are you an existing Patient?

Patient Name (required)

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Medicare No: (required)

Service(s) Requested (Please tick)
Standard EEGAmbulatory EEGProlonged EEG (3+ Hrs)Sleep Deprived EEGNerve Conduction Upper LimbsNerve Conduction Lower Limbs

Reason for test:

Please note our PHONE NUMBER 8267 5547 is currently down and we are working to rectify the situation as quickly as possible. 

We have a temporary phone number 7231 1975 or you can contact us via email at medrecords@auscas.com.au