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Doctors Referral

Your doctor can refer you to MediGreen clinic by sending a referral by fax (03) 9964 3811, by e-mail info@medigreenaustralia.com.au or fill online referral form.

Patient Details

Full Name*

Date of Birth*

Phone*

Medicare Number

Doctor Details

Name*

First Last

Phone*

Speciality

Provider number

Practice name

Health Summary

Max. file size: 128 MB.

Upload Doctor Referral Form

Max. file size: 128 MB.

Referral Details

Consent*

I agree to the following

I have discussed all registered / conventional options with the patient for the indication.
I agree to the CA Clinics privacy policy and terms & conditions.
We will provide the services of a specialist prescriber and a pharmacist as required for case conferences or team care arrangements.
I hereby refer the above named patient to a doctor at CA Clinics for assessment of suitability for medicinal cannabis

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