Paediatric Home sleep study referral

Paediatric Home Sleep Study Referral

Patient Name(Required)

First Last

Patient Date of Birth(Required)

Patient Phone Number(Required)

Patient Email Address

Reason for referral(Required)

Snoring

Suspected OSA

Witnessed apnoeas

Restless Sleep

Daytime tiredness/behavioural concerns

Other (please specify in medical history below)

Relevant Medical History(Required)

Referring Paediatric Sleep & Respiratory Physician Name(Required)

First Last

Referring Physician Practice Name(Required)

Referring Physician Practice Location(Required)

Street Address Suburb State Post code

Referring Physician Provider Number(Required)

I have explained the home sleep study setup process, including sensor placement and overnight monitoring requirements.(Required)

I agree

My patient understands that Newcastle Health Enterprise is a private billing practice(Required)

Home sleep study cost – $680 private fee (no Medicare rebate currently available for home sleep studies)

I agree

Referring Physician Signature(Required)

Today's Date(Required)

Newcastle Health Enterprise
218 Pacific Hwy
CHARLESTOWN NSW 2290

Entrance via Pearson St Mall

P: 02 4955 8044

F: 02 4955 8055

admin@newcastlehealthenterprise.com.au