Provis Rudd Clinic
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  • ABOUT US
  • OUR SERVICES
  • PATIENT INFO
  • DOCTOR INFO
  • CONTACT US
DOCTOR REFERRAL FORM
The Rudd Clinic and Provis Endoscopy Clinics would like to thank you for your support in the past and look forward to serving 
you and your patients in the future.
Referral Form 2016
File Size: 161 kb
File Type: pdf
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    GI Endoscopy evaluation and pre-operative Internal Medicine consultation

    *Pre-operative Out of Hospital (OHP) requirements for endoscopy

    As we are an out of hospital premise it is important to engage in a full pre-endoscopy consultation to determine all risk factors and suitability for undertaking the endoscopic procedure and anesthesia in an out of hospital facility.

    PATIENT MEDICAL HISTORY

    PLEASE NOTE:
    We will make 3 attempts to contact the patient.  Your patient can call for an appointment 3 business days after referral is sent.
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