Adelaide MaxFax referral form for medical practitioners

For your convenience we’ve provided two ways to send referrals to us online. You can fill out and submit the form below to provide us with all the details we need.  If you want to make future referrals faster, you can register with us so that your details will be saved for next time. If you’re a returning practitioner and you have an account already, don’t forget to log in.

A medical practice can register, and a medical practitioner can log in using the practice user name and password, or a medical practitioner can register and set up their own personal user name and password with a different email address. 

Alternatively you can use the quick referral letter upload form to send us a scanned version of your own referral letter. 

Quick referral
letter upload

Use this form to upload a scanned referral letter in JPG, Word (doc/docx) or PDF format.

Supported files: doc, docx, pdf, jpg
Step 1 of 4

Referring Information

IMPORTANT: This form is to be completed in full by a dentist or medical practitioner to be eligible for Medicare rebate for consultation.