Pathology Request

"*" indicates required fields

First name:*

Last name:*

Date of Birth:*

Please enter your date of birth in the format DD/MM/YYYY

Mobile Phone:*

Email:*

How would you like this repeat prescription delivered?*

I would like a text sent to me via S&N pathology – $25

I would like a printed referral (pick up only) – $25

Describe the symptoms or medical isues that have led to this request (one single topic):*

Important Information

This service is available to existing patients of the practice only.
Pathology requests are issued at the discretion of your doctor and must be clinically appropriate.
A pathology request may not be provided if you have not had a consultation within the last 6 months.
Your doctor may require you to book an appointment (telehealth or in person) prior to issuing a pathology request.
If your request is not clinically indicated, you will be advised to make an appointment.
Results are not discussed via reception. A follow-up appointment may be required to review your results.
A $25 administration fee applies and is payable upon submission. If your request is declined, the fee will be refunded.
Not all pathology qualifies for a Medicare rebate. Any out-of-pocket costs are the patient’s responsibility.
Please allow up to 5 business days for processing.

Please sign:*

Todays Date:*

office use only:

request approved

request declined

appointment required