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ULTRASOUND BOOKING

Referral Form

Ultrasound Hawke's Bay accept referrals from all New Zealand registered medical practitioners including, GPs, specialists, osteopaths, physiotherapists, midwives, and other health professionals.

Complete our online form below to send a referral directly for your patient.

Dr

Mr

Mrs

Ms

Miss

Exam Required

General

Abdo (upper)

Renal

Pelvis

Abdo Pelvis

Thyroid / Neck

Scrotum

Breast (L/R)

Breast (Bilateral)

Other

Obstetric

Dating

T.O.P

Ectopic

NT

Anatomy

Growth

Other

MSK

Shoulder (L)

Shoulder (R)

Elbow (L)

Elbow (R)

Wrist / Hand (L)

Wrist / Hand (R)

Hip / Groin (L)

Hip / Groin (R)

Knee (L)

Knee (R)

Ankle / Foot (L)

Ankle / Foot (R)

Paediatrics

Hips

Renal

Abdo

Vascular

DVT (L)

DVT (R)

Leg Arts (L)

Leg Arts (R)

VV / CVI (L)

VV / CVI (R)

Carotid

Renal Doppler

AV Fistula

URGENT

Clinical Information

Obstetric Dates (if known)

Referrer

Dr

Mr

Mrs

Ms

Miss

Signature (sign with mouse)

This referral will be accepted as an electronically signed referral form.

We will contact your patient to arrange an appointment time. Thank you.

24 Porter Drive (unit 5), Havelock North
Hastings, Hawke's Bay, New Zealand.

Phone (06) 650 6744 Email: admin@ultrasoundhb.co.nz

Parking is available at the front on Porter Drive.
Alternatively, free council car parking is available at the rear of the building.

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