SYDNEY CARDIOLOGY REFERRAL FORM

PATIENT NAME	
DATE OF BIRTH	
PHONE	
ADDRESS	

•	¥	≤	CONSULTATION
•	¥	≤	URGENT CONSULTATION
•	¥	≤	ECHOCARDIOGRAPHY
•	¥	≤	STRESS ECHOCARDIOGRAPHY (AND ASSOCIATED CONSULTATION)
•	¥	≤	HOLTER MONITOR
•	¥	≤	AMBULATORY BP MONITORING
•	¥	≤	HYPERTENSION SCREENING (AND ASSOCIATED CONSULTATION)
•	¥	≤	EXECUTIVE HEALTH CHECKS
•	¥	≤	STRAIN ECHOCARDIOGRAM

REFERRING DOCTOR	
PHONE	
DATE	
PROVIDER NUMBER	

CARDIOLOGISTS
DR ANDREW TERLUK
DR JAMES WONG 
DR BILL PETRELLIS 
DR FIONA FOO
DR GUNJAN AGGARWAL
DR ABHINAV LUHACH 
DR MARTIN BROWN
DR RU-DEE TING

LOCATIONS

Bella Vista
Suite 213, Q Central, 10 Norbrik Drive, Bella Vista 2153
Phone (02) 9422 6000 Fax (02) 9899 6446
Blacktown
Suite 4
15-17 Kildare Road 
Blacktown 2148
Phone (02) 9422 6050 Fax (02) 9676 8900
Chatswood
Suite 901, Level 9, Tower B
799 Pacific Highway 
Chatswood 2067 
Phone (02) 9422 6040 Fax (02) 9411 1904
Parramatta 
Suite 501, B1Tower
118 Church Street
Parramatta 2150
Phone (02) 9422 6060 Fax (02) 9635 1247 
Sydney City Cardiology
Suite 13.03
Level 13
68 Pitt Street, Sydney 
Sydney NSW 2000
Phone (02) 9422 6080
Fax (02) 9422 6081

GP ACUTE 24HR SERVICE
9966 7700
MEDICAL PRACTITIONERS ONLY

WWW.SYDNEYCARDIOLOGY.COM.AU