(02) 4393 5550
receptiondrparkin@gmail.com
Dr David Parkin
Services
Gastroscopy
Colonoscopy
Other Services
Resources
Hospital Information
For GPs
Direct access endoscopy referral
Contact
Private direct access endoscopy e-referral
Please fill in the below fields to create a referral request for your patient for a direct access endoscopy. We will contact your patient shortly.
Referral for
(Required)
Gastroscopy
Colonoscopy
Oesophageal Dilatation
Other
Other (Please note)
Patient Details
Name
(Required)
Date of Birth
(Required)
Contact Number
(Required)
Medicare Number
(Required)
Does the patient have private health?
(Required)
Yes
Self-Funded
Private Health Fund & Membership Number - No Gap for Health Funds
Indications
Check all that apply
Abdominal Pain
PR Bleeding
Reflux
Dysphagia
Change in Bowel Habit
Weight Loss
Diarrhoea
Polyp Surveillance
FOB+
Family History
Check all that apply
Oesophageal Cancer
Gastric Cancer
Colon Cancer
Details
Co-Morbidities
Check all that apply
Cardiac
Respiratory
Renal
Diabetic
Major Surgery
Weight
Other
Details
Medications/Blood Thinners
Bloods
Hb
Ferritin
UEC/GFR
Other
Additional Notes
Referring Doctor Details
Referring Doctor Name
(Required)
Provider Number
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Contact Number
(Required)
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