Referral form

If you are a medical health professional and want to refer one of your patients to any specialist in our multidisciplinary team at Sydney Gut Clinic, please download the right referral form and fill in the relevant information.

Whether you want to refer them for a specialist consultation or refer them to a doctor for testing and reporting, our doctor referral form will allow you to indicate what’s required. 

If you are experiencing any trouble downloading the form, please contact our team and we will guide you on what needs to be done. Please note that you will need to send the referral form via the email address provided, once completed.

Appointment request

If you want to request an appointment, please download our appointment request form and fill in the details provided. Once you’re done, click the ‘submit’ button at the end of the form and we will receive it automatically—you aren’t required to send a separate email.

To submit your doctor referral successfully, please fill in all the boxes marked with an asterisk.

Direct access

For our direct access referral form, please click the download button under the ‘Direct access’ section below. Fill in all the information required and send the form to us via email. 

Additional information is provided at the bottom of the form for your reference.