Book - Gippsland Lakes Medical Imaging

03 5152 7805

Referrer Portal

Patient Portal

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Please select the appropriate form below to begin your booking
request. Alternatively you can call us on 03 5152 7805 to make a booking.

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Patient Bookings

Submit a Booking Request
Please complete the form below.
Our team will be in touch with the patient to arrange the booking.

Full Name*

DOB

Phone*

Doctor Name

Doctor Phone

Preferred Date

Preferred Time

Referral (optional) *Insert FIle* Upload a file or drag and drop. up to 10MB

Preferred Location

Message*

Submit a Booking Request
Please complete the form below.
Our team will be in touch with the patient to arrange the booking.

Patient Name*

Ptient DOB

Patient Phone

Doctor Phone

Doctor Name*

Referral (optional) *Insert FIle* Upload a file or drag and drop. up to 10MB

Message*

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