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Referral templates

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Dec 5, 2017

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Referral templates

GIE accept both electronic and paper referrals for patients requiring our Open Access endoscopy service.

Electronic referral templates

The electronic template is available for Medical Director (MD), Best Practice (BP), PractiX, Zedmed and Genie programs. Please see below, the GIE referral templates and the instructions required to import the forms into your clinical program. Please remember to SAVE the template to a folder or to your desktop prior to opening the template. PLEASE DO NOT OPEN IN MS WORD.

If you would like our Marketing and Business Liaison Officer to visit and import this template for you, please call one of our four locations and leave a request.

Paper template

To download the printable referral form (with practice locations) please click here (PDF 654kb).

thumbnail of front of referral pad thumbnail of back of referral pad with maps