Make A Referral

If you are a practitioner looking to refer a patient please complete the details below.

Referral Form

For Medicare purposes referrals to MHCK need to be made by your treating physician (General Practitioner or Specialist).

If you prefer to fax please download a PDF version of our form here and fax it through to: (03) 93456580.

Patient Details

Name*
Address*
Date Of Birth*
Day
Month
Year
Phone Number*
Email*

Clinical History

Investigations Requested (please tick)

Requesting Doctor

Referring Dr*
Provider Number*
Phone Number*
Clinic Name*
Date*
Day
Month
Year

   CLINIC HOURS

Monday 8:30 – 5:00
Tuesday 9:00 – 4:00
Wednesday 8:30 – 5:00
Thursday 8:30 – 5:00
Friday 8:30 – 5:00

 (03) 9345 6414

(03) 9345 6580

reception@mhck.com.au

   CLINIC LOCATION

Level 3, Suite 3.8,
48 Flemington Road
Parkville, Vic 3052

Make A Referral

If you are a practitioner looking to refer a patient please complete a referral form here and we will get back to as soon as possible.

MAKE A REFERRAL