Telehealth

Booking form

Please fill in the online booking form below, upload the referral and we will contact your patient shortly.

Editable Referral
[OR] Fill in an online referral form available here and send to us at bookings@cqradiology.com.au
SMS Booking

Take a photo of the written referral and send via SMS to us at 0472 847 816.

Fax/Email
Fax your referral to (07) 4921 8899 or email a referral letter to bookings@cqradiology.com.au

REFERRER'S ONLINE BOOKING

Referrer Information
Full Name*:

Practice Name*:

Email*:

Patient Information
Full Name*:

Contact Number*:

Patient DOB*:

For what scan?
X-RayUltrasoundCT ScanMRIOPGCardiac CTCone Beam CTEchocardiographyInterventional ProceduresMammography

Clinical Indications*:
Comments:

Attach your referral form
To ensure we have all the correct information, please upload your referral by clicking on the button below.