Auckland Heart Group
Referral Form
Acute
Elective
ECG Reporting Service
EDI addresses
Links
General Practitioners Area
Referral Form
Please complete the referral form below and click the send button. The details will then be emailed to Auckland Heart Group.
To obtain a printable version to fax to us,
download the PDF version (42kb)
.
Please note that fields marked * are mandatory
Patients Detail
Referral to *
First available Consultant
Dr Jim Stewart
Dr Nezar Amir
Dr Ted Clarke
Dr Arthur Coverdale
Dr Rob Doughty
Dr Colin Edwards
Dr Chris Ellis
Dr Tom Gentles
Dr Ivor Gerber
Dr David Heaven
Dr Malcolm Legget
Dr Ross Nicholson
Dr John Ormiston
Dr Peter Ruygrok
Dr Warren Smith
Dr Ralph Stewart
Dr Fiona Stewart
Dr Tim Sutton
Dr Niels van Pelt
Dr Cara Wasywich
Patients Name *
Date of Birth *
Address *
Phone Numbers *
Consultation
24hr ABU
Carotid Ultrasound
Treadmill
Echocardiogram
Renal Ultrasound
Follow up
Stress Echo
MRI
ECG (Resting)
DSE
Myocardial Perfusion scan
24hr Holter Monitor
Clinical Details *
Referral Details
Doctor's Name *
Phone *
Fax *
NZMC *
Medical Centre *
Email *
Postal Address *
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