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FJI NRSI SACROILIAC

EPIDURAL

Claremont 9284 6900

CT GUIDED SPINAL SITE

PROLOTHERAPY RHIZOTOMY (RFA)

SHOULDER JOINT HIP KNEE

CT GUIDED JOINT

ANKLE HYDRO DILATION

RIGHT LEFT

FOOT WRIST

SAB GTBULTRASOUND GUIDED

OTHER

RIGHT LEFT

PRP SYNVISC

MORTON’S ETHANOL ABLATIONADVANCED SITE

PERIPHERAL NERVE BLOCK

Clin

ical

His

tory

DIAGNOSTIC EXAMINATION

X-RAY: LOW DOSE CT:

ULTRASOUND:

MORTON’S RFA DUROLANE

Signature:

Copy To:

Telephone Urgent: PH

Date:

OFFICE USE ONLY

IDENTIFICATION VERIFICATION CLERICAL MIT

Patient Indetification VerifiedProcedure VerifiedCorrect Site & Side VerifiedCorrect Patient Data & Labelling

STAFF MEMBER INITIALS

YYY

YYYY

20180220ReferralPadMSKV1.4

imagingcentral.com.au

imagingcentral.com.au

My

Appo

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ent Date:

Time:

Location:

Other:

For more information about your procedure/examination please visit imagingcentral.com.au

CLAREMONT PRACTICE345 Stirling Hwy, Claremont

PH: 9284 6900Fax: 9284 2955

DIGITAL X-RAY CT SCAN ULTRASOUND QCT BONE DENSITOMETRY

Opening Hours:

CLAREMONT PRACTICE PARKING

Monday - Friday 8:30am - 5:00pm Parking also available at front and rear of premises.

Stirling Hwy

Bayview Tce

Stirling Rd

Queenslea Dr

St Quentin Ave Church LnAvion Way

Gugeri St

Bovell Ln

Freshwater Pde

Claremont Cres

Park Ln

Mount St

Chatsworth Tce

Bayview Tce

+

CLAREMONT QUARTER

CLAREMONT PRACTICE345 Stirling HwyClaremont

INTERVENTIONAL

Imaging Central is a premier diagnostic and interventional radiology clinic. We are an independent radiology practice, owned and operated by radiologists.Imaging Central stores your images for FIVE years. Visit us for all your medical imaging and create a complete record which your referrer can access 24/7.

Your referrer has recommended you use Imaging Central. You may choose Please ask our team about our concessions for health care and pension concession card holders.

Stirling Hwy

Bayview Tce

Stirling Rd

Queenslea Dr

St Quentin Ave Church LnAvion Way

Gugeri St

Bovell Ln

Freshwater Pde

Claremont Cres

Park Ln

Mount St

Chatsworth Tce

Bayview Tce

+

CLAREMONT QUARTER

wOVER 125+ BAYS

FREE 2HR TICKET PARKING

WE ARE HERE

Parking entrance located on St Quentin Ave next to ANZ