Perth's Leading Specialist in the Treatment of Varicose Veins


Referral Form

Referral Form

Ultrasound Imaging Request Form

Medicare requires an Ultrasound Imaging Request Form for any services performed under ultrasound guidance,  in order for patients to receive their maximal Medicare rebate. This form is different and separate from your GP’s referral letter.

Ultrasound imaging is a crucial component to all that we do at The Vein Clinic.

In order for patients to obtain maximal Medicare benefits for their attendances, individual Ultrasound Imaging Request forms are required for diagnostic scans, ultrasound-guided treatments, and ultrasound follow-up.

Download the form below and have it signed by your general practitioner in order to claim your Medicare rebate.




Get In Touch

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

Unsure of what vein condition you may have? Please assess your legs with our online tool.


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