Patient referral

Melbourne Sports Health Clinic

For health professionals referring a patient to Dr Rebecca Beaton. All fields marked * are required.

Privacy: BEO Health Solutions Pty Ltd, trading as Melbourne Sports Health Clinic, collects patient and referrer details, clinical information, signatures and uploaded documents to assess and manage the referral, provide care and communicate about its outcome. Snapforms processes submissions for the clinic; relevant records are filed in Zedmed. Missing required information may prevent us from processing the referral.

Please ensure you have the patient’s consent or another lawful authority to share their information. Our Privacy Policy explains how information is handled, including service providers, access and correction, and complaints. Privacy enquiries: admin@melbournesportshealthclinic.com.au or 0437 407 854.

This form is not monitored for emergencies. Call 000 or attend the nearest emergency department if emergency care is needed. Submitting a referral does not confirm an appointment.

Patient details

Patient first name *

Patient surname *

Date of birth *

Patient phone *

Medicare number

Patient email

Patient address

Clinical information

History of symptoms / injury *

Diagnosis / imaging findings *Include the working diagnosis and any relevant findings. If imaging is not available, please state this.

Previous care

Previous interventions for this conditionFor example: physiotherapy, immobilisation, injections or surgery.

Referrer details

Referrer full name *

Referrer address *

Provider number *

Referrer email

Referrer phone

Would you like to receive correspondence on the outcome of this referral? *

YesNo

Referrer signature *

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Referral date *

Supporting documents

Upload supporting documents

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Attach the referral letter, relevant imaging reports, discharge summaries or other supporting documents. PDF, JPG, PNG, DOC or DOCX; maximum 20 MB per file.