Send an eReferral Thank you for trusting us to care for your patient. We take this very seriously. Step 1 of 3 33% Referring Providers InformationName(Required)Provider Number(Required)Practice Name(Required)Practice Phone Number(Required)Who would you like to see your patient?Which Doctor would you like your patient to be seen by?(Required) Open referral to any provider Dr Hasher Kadavil (Berkeley Vale & Gosford) Dr Steve Bruce (Charlestown) Dr John Prickett (Charlestown, Maitland) Dr Simon Tame (Not currently accepting referrals) Patient DetailsPatients First Name(Required)Patients Last Name(Required)Patients Date of Birth(Required) DD slash MM slash YYYY Patients Phone Number(s)(Required)Patient's Email(Required)Patient's Address(Required)Patients Fund Status(Required)Select OneUninsuredPrivately InsuredDVA WhiteDVA GoldThird Party (WC/CTP)Unsure of status, check with patientMedicare NumberPlease enter a number less than or equal to 0.Health Fund NameMember No.Insurer(Required)Claim Number(Required)Date of Injury DD slash MM slash YYYY Case Manager NameCase Manager Phone Number Clinical Reason for ReferralReason for Referral(Required)Our Doctors book out a few months in advance, so it is important to have a detailed referral so it is able to be triaged accordingly. Your Name(Required)Referring Doctors Signature(Required)Section Break Meet your team Dr John Prickett Dr Hasher Kadavil Dr Steve Bruce Dr Arvind Kendurkar Phil Rees Mitch Bowd Dr Mike Shelley Justine Clark Suzanne Osei Tara
