Referral forms to outpatient services

To refer a patient, referrers will need to complete one of the standardised referral forms (external site) and send it to the CRS. The CRS prefers referral forms sent by secure messaging. Referrals are sent via secure messaging at, Healthlink Secure Messaging: crefserv.

The catchment map (PDF) outlines the suburb catchment areas for Sir Charles Gairdner Hospital and North Metropolitan Health Service.

 

Service Form Criteria / Notes Contact
Bone Density Bone Density Referral Form (PDF) HealthLink EDI: scg8gbds Tel: (08) 6457 3891
Fax: (08) 6457 4109
Email: SCGH.BoneDensity@health.wa.gov.au
Breast Centre CRS Forms (external site) For urgent referrals contact the General Surgery Unit 4 Registrar, via switchboard (08) 6457 3333 Tel: (08) 6457 4590
Fax: (08) 6457 4897
Dietetics and Nutrition OPH Dietetics Referral Form (Word) No external or GP referrals are accepted. Refer to OPH (external site). Tel: (08) 6457 2850
Fax: (08) 6457 1130
Gastroscopy and Colonoscopy CRS Forms (external site) Referral Guidelines for upper GI Endoscopy and Colonoscopy (external site) CRS - Healthlink Secure Messaging: crefserv
General High Dependency Unit (GHDU)   External patients are referred by their primary medical team by contacting the ICU Senior Registrar via switchboard (08) 6457 3333. Tel: (08) 6457 3333
Intensive Care Unit (ICU)   External patients are referred by their primary medical team by contacting the ICU Senior Registrar via switchboard (08) 6457 3333. Tel: (08) 6457 3333
Multidisciplinary foot ulcer clinic (MDFUC) MDFUC Referral Form (PDF) For urgent referrals contact the on-duty Vascular Registrar via switchboard (08) 6457 3333. Tel: (08) 6457 3373
Fax: (08) 6457 1568
Nuclear Medicine Nuclear Medicine Referral (PDF) Inpatient Checklist (PDF) Tel: (08) 6457 2322
Fax: (08) 6457 3610
Ophthalmology CRS Forms (external site) For urgent referrals contact the on call registrar via switchboard (08) 6457 3333. Tel: 1300 855 275
Email: SCGH.Eyeclinic@health.wa.gov.au
Psycho-Oncology Service Psycho-Oncology Referral Form (Word)   Tel: (08) 6457 1177
Fax: (08) 6457 1178
Email: WAPOS@health.wa.gov.au
Renal Medicine Renal Specialist Referral Form (Word) Outpatient Referrals should be sent to the Central Referral Service (CRS) (external site). For urgent referrals, please contact the on-call Renal Registrar or Renal Physician. Tel: (08) 6457 2799
Fax: (08) 6457 3942
Respiratory Medicine CRS Forms (external site) Urgent referrals should be discussed with the appropriate Physician or Registrar and arrangements will be made to accommodate emergencies. Tel: (08) 6457 1756
Fax: (08) 6457 1555
Social Work   Referrals for social workers and welfare officers are accepted from patients, families/carers, multidisciplinary team members, community agencies and general practitioners. Tel: (08) 6457 4666
Fax: (08) 6457 4906
Speech Pathology   No direct GP referral or nursing home patients accepted for outpatient services. Tel: (08) 6457 2044
Fax: (08) 6457 4103
State Head Injury Unit (SHIU) SHIU Referral Form (Word) Referrals accepted from any sources for individuals residing anywhere within Western Australia. Tel: (08) 6457 4488
Fax: (08) 6457 4489
Email: SHIU@health.wa.gov.au
Visual Electrophysiology Clinic Upon request Referrals may only be made by ophthalmologists using the Visual Electrophysiology request form which can be sent or faxed to the department. Phone or email bookings may be made but must be followed up with a request form. Tel: (08) 6457 2866
Fax: (08) 6457 3466
Email: SCGHMTP@health.wa.gov.au
WA PET Department PET Oncology Referral Form (PDF)
PET Cardiology Referral Form (PDF)
PET Neurology Referral Form (PDF)
Inpatient Checklist (PDF) Tel: (08) 6457 2322
Fax: (08) 6457 3610
Youth Cancer Service Youth Cancer Service Referral Form (Word)   Tel: (08) 6383 3416
Fax: (08) 6383 3450

Last Updated: 28/10/2021