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Patie
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imagingcentral.com.au
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FJI NRSI SACROILIAC
EPIDURAL
Claremont 9284 6900
CT GUIDED SPINAL SITE
PROLOTHERAPY RHIZOTOMY (RFA)
SHOULDER JOINT HIP KNEE
CT GUIDED JOINT
ANKLE HYDRO DILATION
RIGHT LEFT
FOOT WRIST
SAB GTBULTRASOUND GUIDED
OTHER
RIGHT LEFT
PRP SYNVISC
MORTON’S ETHANOL ABLATIONADVANCED SITE
PERIPHERAL NERVE BLOCK
Clin
ical
His
tory
DIAGNOSTIC EXAMINATION
X-RAY: LOW DOSE CT:
ULTRASOUND:
MORTON’S RFA DUROLANE
Signature:
Copy To:
Telephone Urgent: PH
Date:
OFFICE USE ONLY
IDENTIFICATION VERIFICATION CLERICAL MIT
Patient Indetification VerifiedProcedure VerifiedCorrect Site & Side VerifiedCorrect Patient Data & Labelling
STAFF MEMBER INITIALS
YYY
YYYY
20180220ReferralPadMSKV1.4
imagingcentral.com.au
imagingcentral.com.au
My
Appo
intm
ent Date:
Time:
Location:
Other:
For more information about your procedure/examination please visit imagingcentral.com.au
CLAREMONT PRACTICE345 Stirling Hwy, Claremont
PH: 9284 6900Fax: 9284 2955
DIGITAL X-RAY CT SCAN ULTRASOUND QCT BONE DENSITOMETRY
Opening Hours:
CLAREMONT PRACTICE PARKING
Monday - Friday 8:30am - 5:00pm Parking also available at front and rear of premises.
Stirling Hwy
Bayview Tce
Stirling Rd
Queenslea Dr
St Quentin Ave Church LnAvion Way
Gugeri St
Bovell Ln
Freshwater Pde
Claremont Cres
Park Ln
Mount St
Chatsworth Tce
Bayview Tce
+
CLAREMONT QUARTER
CLAREMONT PRACTICE345 Stirling HwyClaremont
INTERVENTIONAL
Imaging Central is a premier diagnostic and interventional radiology clinic. We are an independent radiology practice, owned and operated by radiologists.Imaging Central stores your images for FIVE years. Visit us for all your medical imaging and create a complete record which your referrer can access 24/7.
Your referrer has recommended you use Imaging Central. You may choose Please ask our team about our concessions for health care and pension concession card holders.
Stirling Hwy
Bayview Tce
Stirling Rd
Queenslea Dr
St Quentin Ave Church LnAvion Way
Gugeri St
Bovell Ln
Freshwater Pde
Claremont Cres
Park Ln
Mount St
Chatsworth Tce
Bayview Tce
+
CLAREMONT QUARTER
wOVER 125+ BAYS
FREE 2HR TICKET PARKING
WE ARE HERE
Parking entrance located on St Quentin Ave next to ANZ