Locations
All Branches
Clarence Valley Imaging
North Coast Radiology
Ballina
Byron Bay
Casino
Goonellabah
Lismore (North Coast Radiology)
Lismore (Northern Rivers Women’s Imaging)
Lismore (Nuclear Medicine)
Qscan (Qld)
Services
All Services
Bone Density (BMD)
DXA Body Composition
CT Scan
Dental Imaging
Interventions & Procedures
MRI
Mammography
Nuclear Medicine
Ultrasound
X-Ray
Patients
Support Centre
Appointment Bookings
Request Appointment
Upload referral
Change or Cancel Appointment
Patient Information Sheets
Understanding the Appointment Process
Patient FAQ
Billing & Payments
Medicare Information
Copies of Examinations
Patient Portal – access to images
Referrers
Online access to Results & Images (InteleConnect)
Doctor Portal – Online access to results and images
Referral Forms
E-Referrals
Diagnostic Imaging Pathways
Update/New Referrer or Practice Information
Software Downloads
Request or grant access to an examination
Medicare Guidelines
for Doctors
for Allied
About Us
Company Information
Our Radiologists
Careers
News
Contact Us
Contact Us
Compliments Suggestions Complaints
Patient Survey
Referrer Survey
Request Appointment
Change or Cancel Appointment
Careers
Locations
All Branches
Clarence Valley Imaging
North Coast Radiology
Ballina
Byron Bay
Casino
Goonellabah
Lismore (North Coast Radiology)
Lismore (Northern Rivers Women’s Imaging)
Lismore (Nuclear Medicine)
Qscan (Qld)
Services
All Services
Bone Density (BMD)
DXA Body Composition
CT Scan
Dental Imaging
Interventions & Procedures
MRI
Mammography
Nuclear Medicine
Ultrasound
X-Ray
Patients
Support Centre
Appointment Bookings
Request Appointment
Upload referral
Change or Cancel Appointment
Patient Information Sheets
Understanding the Appointment Process
Patient FAQ
Billing & Payments
Medicare Information
Copies of Examinations
Patient Portal – access to images
Referrers
Online access to Results & Images (InteleConnect)
Doctor Portal – Online access to results and images
Referral Forms
E-Referrals
Diagnostic Imaging Pathways
Update/New Referrer or Practice Information
Software Downloads
Request or grant access to an examination
Medicare Guidelines
for Doctors
for Allied
About Us
Company Information
Our Radiologists
Careers
News
Contact Us
Contact Us
Compliments Suggestions Complaints
Patient Survey
Referrer Survey
Request Appointment
Change or Cancel Appointment
Careers
E-Referral Dental
E-Referral Dental Form
Patient Details
Patient Name
*
Date Of Birth
*
DD/MM/YYYY
Phone Number
*
Gender
*
Female
Male
Other
Patient Email Address
Booking Appointment
Radiology practice will call patient to arrange appointment
Patient will initiate appointment
Examination
OPG
OPG Impacted teeth, caries, periodontal or periapical pathology - 57963
OPG trauma, infection, tumours, congenital or surgical conditions of teeth or faciomaxillary region - 57960
OPG Missing or crowded teeth or developmental anomalies of the teeth or jaw - 57966
OPG Temporomandibular joint arthrosis or dysfunction - 57969
Xray
Xray Lateral cephalogram please indicate overjet
Xray Temporomandibular joints
Malocclusion
-10
-8
-6
-4
-2
0
+2
+4
+6
+8
+10
Other
OPG
Xray
Exam details
Clinical History
Exclude
Investigate
Monitor
Confirm
Clinical details
*
Referring Practitioner
Referrer Name
*
Practice Email
*
PACS User or RIS ID
*
(Used to login to InteleViewer or Inteleconnect)
Provider Number
*
Practice Address
Copies to another referrer?
Yes
No
Copy to:
*
I am entitled under the Health Insurance Act 1973 (Cth) to make this request
Branch
*
Ballina
Byron
Casino
Goonellabah
Grafton
StVincents
Please select a branch but the appointment might be at another branch. Note OPG not available at St Vincents and Maclean.
Branches
Please select most appropriate branch but the appointment may be at another branch.
North Coast Radiology (Coastal)
Ballina (OPG & Xray)
Byron Bay (OPG & Xray)
North Coast Radiology
Casino (OPG & Xray)
Goonellabah (OPG & Xray)
St Vincents Lismore (Xray)
Clarence Valley Imaging
Grafton (OPG & Xray)
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