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.