Follow the steps to complete your referral form with ease.

1. Use the ‘Get Form’ button to initiate the process and access the form in an online editor.
2. Provide patient information. Fill in the title (choose from options such as Dr, Mr, Mrs, Ms, or Other), first name, surname, date of birth, and address. Additionally, enter the phone number and Medicare number, and indicate if you have a Health Care Card, Pension Card, or DVA by checking the appropriate boxes.
3. If applicable, provide the concession number and indicate if the patient is Aboriginal or Torres Strait Islander or a Refugee/Asylum Seeker.
4. Next, specify the assistance requested, including if a language interpreter is needed and the preferred location for the clinic visit.
5. Select an appointment preference by ticking the preferred day of the week and either AM or PM for the appointment slot.
6. In the patient clinical details section, provide the reason for referral and any relevant medical and ocular history or findings.
7. Fill in the visual acuity and current prescription for both the right and left eye, and indicate if the patient is under current ophthalmic care.
8. Complete the referrer details section. Indicate the profession and fill in the practitioner's name, practice/department name and address, Medicare provider number if applicable, and sign with the date.
9. Indicate if a Team Care Arrangement is requested by checking yes or no. If yes, be prepared to provide applicable forms.
10. Once all relevant fields are filled, you can save the changes, download the form, print it, or share it according to your needs.

Complete your REFERRAL FORM online today for a seamless experience.