Practitioner Imaging Referral

Imaging Referrals can now be completed and submitted online by Practitioners – simply complete the form below. The completed referral will be delivered to Synergy Radiology and the Patient’s email address when provided. Our bookings team will contact the patient directly via phone to arrange an appointment.

This form is for Practitioners only. We will confirm with the referring practitioner the validity of this request. For patients wishing to request an appointment please click “REQUEST A BOOKING VIA FORM

To receive a copy of the referral for your patient records please tick “Send a copy to me”

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