New Referral Online Form

Please complete the Online Form Sections that are applicable to your specific referral requirements.
There are 3 options below, and they include:

  • Referral from your GP or Specialist;
  • Work Cover Referrals;
  • Veteran Affairs &/OR Military Referrals.

If you do not have all information required to complete the form below, please contact our office directly OR complete the general enquiry form at the bottom of this page. Thank you !

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NEW REFERRALS ONLINE FORM

PLEASE COMPLETE ONE OF THE 3 OPTIONS BELOW:

1) GENERAL REFERRALS





YesNo




2) WORK COVER REFERRALS





YesNo



3) VETERAN AFFAIRS/MILITARY REFERRALS





YesNo


Our administrative staff will be in contact with you to arrange a consultation appointment within the next 3 working days. Thank you for completing our online form !

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PLEASE NOTE :

Mr Malham does NOT consult TAC Patients with overseas insurance or patients who are uninsured (This includes patients with only Private Extras Cover).

Mr Malham does not operate at Public Hospitals.

If you do not have any of the above (Private Health Insurance, a Consultation Approval letter from Work Cover or Gold Card or White Card for Veteran Affairs / Military Referrals), we are unable to arrange a consultation appointment for you.

Please call our rooms if you have any questions. Thank you!

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CONTACT DETAILS

Mr Malham’s Private Consulting Rooms

Suite 2 Level 1,
517 St Kilda Rd,
Melbourne VICTORIA
3004

Email: admin@gregmalham.com.au

Phone: (03) 9866 6650
Fax : (03) 9866 6681

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Epworth Richmond

89 Bridge Rd,
Richmond VICTORIA
3121

Phone: (03) 9426 6666

GENERAL ONLINE ENQUIRIES :

CONNECT WITH US

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