Georges River Online Referral Form

Radiology Request Form

Diagnostic Imaging, Interventional Procedures +/- Consultation

Billing(Required)
(Please attach Approval Form)
Date(Required)
Gender(Required)
Date Signed(Required)
Signed Date
Pregnant / Breastfeeding

Results Preferences


Urgent Results Required?
Film
DICOM CD
Report Only
Report Only
Referrer PACS Portal
Referrer PACS Portal

GEORGES RIVER MEDICAL IMAGING
REVESBY VILLAGE CENTRE MEDICINAL PRECINCT, LEVEL 1, SUITE 5 CNR MACARTHUR AVE & BRETT ST
PH: 8397 6400 E: grmi@xray.com.au