Patient Referral

You can refer a patient to the Mind + Gut Clinic by using the online referral form below.

Alternatively, you can make a referral by phone on P 03 9290 9812 or fax 03 9525 9358 or email at info@mindgutclinic.com.au

At Mind + Gut we believe that the more information we have about your patient, the better. Please feel free to include us on any appropriate correspondence with their GP, Gastroenterologist or other Specialist Services. Mind + Gut will also correspond with you directly once your patient has been seen for an initial consultation.

Patient Details

* Patient Name
* Date of Birth
Address
Phone Number

Referral Information

* Reason for Referral
Relevant History
Previous Investigations/Results
Correspondence Documents (Optional)
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Referrer Details

* Name
* Phone Number
Fax
* Address
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