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Perth's Leading Specialist in the Treatment of Varicose Veins

Dr Luke Matar | MBBS, FRANZCR, FACP

Referral Form

Referral Form

Ultrasound Imaging Request Form

In order for patients to receive a Medicare rebate for any services performed under ultrasound guidance, an Ultrasound Imaging Request form is required.
This form is different and separate from a GP referral letter.

Ask your GP for an Imaging Request or download the template form below and have it signed.

Download

 

 

Get In Touch

Please send us an email and we’ll be in contact very soon or alternatively, call us on (08) 9200 3450.

If you are unsure of what vein condition you may have,  assess your legs with our online tool.

If you are looking for cosmetic spider vein treatment only, please click here.

 

 

    You're welcome to attach a photo of the area of your legs that concerns you (Maximum File Size 5MB).