For Patients & Referring Doctors
Download Referral Forms
A completed referral is required before any procedure at Direct Endoscopy. Download the form for the procedure you need below, have your GP or specialist complete and sign it, and we will take care of the rest. The endoscopy referral form is a fillable PDF that can be typed into directly, and every form can be printed and completed by hand.
Colonoscopy
Referral form for colonoscopy, including procedures following a positive bowel screening test, symptoms, family history or polyp surveillance.
Download formGastroscopy
Referral form for gastroscopy to investigate reflux, heartburn, swallowing difficulties, abdominal pain and other upper digestive symptoms.
Download formCapsule Endoscopy
Referral form for capsule endoscopy, a swallowed-camera examination of the small bowel that other scopes cannot reach.
Download formConsultation
Referral for a specialist consultation with one of our gastroenterologists to discuss symptoms, results or the right procedure for you.
Download formLiver Fibrosis Scan
Referral form for a non-invasive liver fibrosis scan to assess liver stiffness and fatty liver, with no needles and no sedation.
Download formHydrogen Breath Testing
Referral form for hydrogen breath testing to investigate lactose or fructose intolerance and small intestinal bacterial overgrowth (SIBO).
Download formHow it works
1
Download the form
Choose the form for your procedure. If your form is a fillable PDF, open it in Adobe Acrobat to type in and save. Any form can simply be printed and completed by hand.
2
Your doctor completes it
A referral must be completed and signed by your GP or specialist. Take the form to your appointment, or your doctor can download it here directly.
3
Send it to us
Your doctor can send the completed referral straight to us, or you can provide it when you book online. We will then contact you with appointment options.
Need a hand with your referral?
Call us on (03) 9781 5959 and our team will help you with the right form and the next steps.