Locations
All Branches
Clarence Valley Imaging
North Coast Radiology
Ballina
Byron Bay
Casino
Goonellabah
Lismore (North Coast Radiology)
Lismore (Northern Rivers Women’s Imaging)
Lismore (Nuclear Medicine)
Qscan (Qld)
Services
All Services
Bone Density (BMD)
DXA Body Composition
CT Scan
Dental Imaging
Interventions & Procedures
MRI
Mammography
Nuclear Medicine
Ultrasound
X-Ray
Patients
Support Centre
Appointment Bookings
Request Appointment
Upload referral
Change or Cancel Appointment
Patient Information Sheets
Understanding the Appointment Process
Patient FAQ
Billing & Payments
Medicare Information
Copies of Examinations
Patient Portal – access to images
Referrers
Online access to Results & Images (InteleConnect)
Doctor Portal – Online access to results and images
Referral Forms
E-Referrals
Diagnostic Imaging Pathways
Update/New Referrer or Practice Information
Software Downloads
Request or grant access to an examination
Medicare Guidelines
for Doctors
for Allied
About Us
Company Information
Our Radiologists
Careers
News
Contact Us
Contact Us
Compliments Suggestions Complaints
Patient Survey
Referrer Survey
Request Appointment
Change or Cancel Appointment
Careers
Locations
All Branches
Clarence Valley Imaging
North Coast Radiology
Ballina
Byron Bay
Casino
Goonellabah
Lismore (North Coast Radiology)
Lismore (Northern Rivers Women’s Imaging)
Lismore (Nuclear Medicine)
Qscan (Qld)
Services
All Services
Bone Density (BMD)
DXA Body Composition
CT Scan
Dental Imaging
Interventions & Procedures
MRI
Mammography
Nuclear Medicine
Ultrasound
X-Ray
Patients
Support Centre
Appointment Bookings
Request Appointment
Upload referral
Change or Cancel Appointment
Patient Information Sheets
Understanding the Appointment Process
Patient FAQ
Billing & Payments
Medicare Information
Copies of Examinations
Patient Portal – access to images
Referrers
Online access to Results & Images (InteleConnect)
Doctor Portal – Online access to results and images
Referral Forms
E-Referrals
Diagnostic Imaging Pathways
Update/New Referrer or Practice Information
Software Downloads
Request or grant access to an examination
Medicare Guidelines
for Doctors
for Allied
About Us
Company Information
Our Radiologists
Careers
News
Contact Us
Contact Us
Compliments Suggestions Complaints
Patient Survey
Referrer Survey
Request Appointment
Change or Cancel Appointment
Careers
Pre Exam Checklist
Pre exam checklist
Your name
*
Attention to:
*
Nurse
CT Tech
Radiologist & Nurse
Sonographer
Other
Other
Branch
*
Ballina
Byron
Goonellabah
Grafton
StVincents
Copy to Email
Patient details
arrowup6
Patient Name
*
Date of Birth
*
Patient Phone
*
Accession #
Date of Exam
*
Time of Exam
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
:
00
05
10
15
20
25
30
35
40
45
50
55
Exam
*
Exam 2
Injection
Biopsy
Other
Other
Referer
Send Prep sheet
N/A
SMS
Email
In person
Prep Sheet
BA Enema
CT General
CT CA
CT Calcium Score
CT Colonoscopy
CT Spinal Injection
MRI Prostate
MRI Enterography
NM MIBI
US Abdo
US Pelvis Renal 1stTri
US 2nd Tri
US 3rd Tri
US MSK Injection
Arrival Time
07
08
09
10
11
12
13
14
15
16
17
18
19
20
:
00
05
10
15
20
25
30
35
40
45
50
55
Email Address
Patient History
arrowup6
Blood Thinners
Yes
No
N/A
Blood Thinner Medication
Thinners for
Diabetic
Yes
No
N/A
Diabetic Medication
Renal Disease
Yes
No
N/A
Renal history
Last Biochem test
Allergies
Yes
No
N/A
Allergie List
Chemotherapy
Yes
No
N/A
in last 7 days
Chemo Date
MRO
Yes
No
N/A
MRO Type
Asthma
Yes
No
N/A
Advised Asthma
Private Insurance
Yes
No
N/A
Driver
Yes
No
N/A
Overnight Bag
Yes
No
N/A
Notes
Procedure
arrowup6
Procedure
Core Biopsy
FNA
Localisation
Lymphoscintigraphy
Joint Injection
Facet
Nerve Root Sheath
Epidural Block
Arthrogram
Ascites
Pleural Drain
Area
Specimen
Yes
No
Localisation
Other
Radiologist
*
Dr Cappe
Dr Dyer
Dr Gillam
Dr Hooper
Dr Lun
Dr Mulholland
Dr Robertson
Dr Singh
Dr Sommerfeld
Dr Pasfield
Dr Toh
Other
Radiologist
File Upload
Drop a file here or click to upload such as referral or last report
Choose File
Maximum file size: 20.48MB
If you are human, leave this field blank.
Submit
Δ
