Online Referral Form

Thank you for referring your patient to the care of Wollongong Eye Specialists.

We appreciate you providing us with information about your patient’s eye health and what they are looking to achieve with our specialist expertise.

You can be confident that we will provide them with the best care for their unique needs and, as their original and ongoing eye health practitioner, we will keep you informed about their progress and treatment success. Patients will return back to your care once their treatment/management is planned.

Your patient will require a referral letter to receive their full Medicare rebate. Please fill out the form below and attach their referral letter.

We look forward to being a part of your patients journey to optimal eye health.

If you would prefer to download, print and email or fax in our referral form click here.

Email: reception@wescentre.com.au
Fax: 02 4227 6399

Patient information

Patient name*

First Last

Address*

Street Address Address Line 2 City State Postcode Country

Date of Birth*

Mobile number*

Clinical information

Upload a referral letter

Max. file size: 2 MB.

Referrer information

Name*

First Last

Practice name*

Provider no.*

Address*

Street Address Address Line 2 City State Postcode Country

Phone number*

Signature*

Date*

Online Referral Form

Thank you for referring your patient to the care of Wollongong Eye Specialists.

For Referrers

Patient information

Referrer information

Providing the best results for your vision using advanced ophthalmic technology.

Wollongong

Warilla

Nowra