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Doctor Referral

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FOR DOCTORS

Doctor Referral

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

Fill Out Form

Referral Online Form

    1 Patient Details
    Required

    2 Doctor Details
    Required

    3 Referral Details
    Required
    Health Summary
    No file chosen Upload your Health Summary file. Max. file size: 128MB. Accepted files: .pdf
    Upload Doctor Referral Form
    No file chosen Upload your Doctor Referral Form. Max. file size: 128 MB. Accepted files: .pdf
    Consent*
    • I have discussed all registered / conventional options with the patient for the indication.
    • I agree to the Medigreen Clinic's 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 Medigreen Clinic for assessment of suitability for medicinal cannabis

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