Patient Details	

Patient Name:	  	
Postal Address:	  	State:	  	Post Code:		
Date of Birth:	  	Phone Number:	  	
Medicare Number:	  			

Examination Required (All testing is bulk billed)	

•	Echocardiogram

•	For HF Symptoms
•	For LVH or LV dysfunction
•	For Valve Disease
•	Other	•	Exercise Test 
(Includes baseline ECG)

•	Treadmill
•	Exercise Bike (Stirling only)	•	Holter Monitor	
•	Stress Echo
(Includes baseline Echo)

•	Treadmill
•	Exercise Bike (Stirling only)
	•	Ambulatory BP Monitor 
Private billing applies. Medicare rebate available only if clinical criteria are met for item 11607	•	Event Monitor (3 days)
	
•	CT Coronary Angiogram
(Includes Specialist review to assess the patient, ensuring a CTCA is clinically appropriate and meets Medicare criteria)	•	 ECG

•	Urgent
•	Please book patient for a Cardiology Consult if indicated by results

Cardiology Consultation	

•	A/Prof Michael Nguyen
Interventional Cardiologist	•	Dr Justin NG
Cardiologist / Electrophysiologist	•	Dr Hassan Kamalddin
Consultant Cardiovascular Physician	
•	Dr Robert Harvey
Interventional Cardiologist	•	Dr Robert Tewksbury
Vascular & Endovascular Surgeon		

Clinical Details	

Medical History / Medications:

Specific Clinical Query?

Referring Doctor	

Name: 	Provider Number: 	
Signature: _____________________
	Date: 	
Practice Name: 	Contact Number: 	
Health Link EDI: 	Dr Email: 	

Copy of the report to: ________________________________________

Please ensure Access Cardiology receives a copy of Patient Discharge Summaries

Primary Locations	

Albany

102 Aberdeen Street
Albany WA 6330
 
	Cottesloe

Shop 3 / 40 Marine Parade
Cottesloe WA 6011
(Inside Soleil Health Medical Centre)	Joondalup

Suite 6 (Ground Floor)
Sanori House
126 Grand Boulevard
Joondalup WA 6027

Mandurah

32 Minilya Parkway
Greenfields WA 6120	Murdoch

Suite 55 (Level 3)
Wexford Medical Centre
3 Barry Marshall Parade
Murdoch WA 6150	Nedlands

Suite 307 (Level 3)
Hollywood Consulting Centre
91 Monash Avenue
Nedlands WA 6009
(Gate 5 Entrance)	

Sessional Locations	

Albany Hospital

Testing:
Zone 2, Albany Hospital
Warden Avenue
Albany WA 6330	Midland

34 Railway Parade
Midland WA 6056
(Located inside Painwest)	Rockingham

Level 1, 18 Civic Blvd
Rockingham WA 6168
(Inside Rockingham Medical & Dental Centre)

Stirling

12 / 732 Karrinyup Road
Balcatta WA 6021
(Inside MedOne Medical Centre)