Stationery

Radiology Victoria customises referral request stationery in the following formats that adhere to the Medicare Benefits Schedule guidelines:

A4 printer paper

Customised A4 printer paper allows you to print laser requests directly from your practice management system.

A4 Radiology Request Form Download

For this option to work effectively, your practice management software must have its printer settings calibrated. For guidance to calibrate your printer, please contact Radiology Victoria Support Team if your practice management system is listed: Best Practice, Genie, ZEDMED. Medical Director and Clinic to Cloud

Radiology A5 Request Form

Download

CT Coronary Angiogram Request Form

Download

Chiropractic Request Form

Download

Dental Request Form

Download

Cardiac MRI Request Form

Download

Handwritten Request Pads

Handwritten request pads have been developed for physicians that do not use a computer-based practice management system or prefer to handwrite requests. These request pads have fields for referrer details, required examination, clinical notes and delivery method. They can be used for any examination.

Personalised handwritten Request Pads

Handwritten request pads have been developed for physicians that do not use a computer-based practice management system or prefer to handwrite requests. Radiology Victoria can customise requests for any referrer. Personalised request pads include a pre-printed referrer name, address, phone, fax and provider number.

Request Referral Pads

To order new referral stationery, please click the link below to fill in our order form. If you are ordering personalised request pads, please ensure the correct details are entered to avoid delays including address, phone, fax, and provider number.

Order referral pads