Professor Hosen Kiat Dr Anil Aggarwala A/Prof David Rees A/Prof Jane McCrohon Dr Young Yu Dr Viswanathan Venkatachalam Dr Victar Hsieh Dr Colin Tso Cardiac Health Institute Referral: External Internal Patient’s Name: Address: Please tick appropriate box 2 Consultation Urgent Same Day Consultation 3 Stress Test 4 Echo 5 Stress Echo 6 Carotid Doppler 7 24hr Holter 8 24hr Ambulatory BP 1 (Must Phone Our Cardiologist First) (With Pre-Test Assessment) (With Pre-Test Assessment) (Eastwood Only) Nuclear Imaging (Eastwood) Stress Sestamibi (Exercise or Persantin) 9 10 Gated Heartpool Scan 11 Myocardial Viability Scan 12 Cardiac Shunt Study Comments: Referring Doctor’s Name: Signature: Date: CHI Eastwood 173 Shaftsbury Road Eastwood NSW 2122 CHI Norwest Norwest Private Hospital & Medical Centre Suite G4, 9 Norbrik Drive Bella Vista NSW 2153 Ph (+61 2) 9858 9888 CHI Hurstville 75 Queens Road Hurstville NSW 2220 CHI Macquarie Macquarie University Clinic Suite 202, Level 2 2 Technology Place Macquarie University NSW 2109 | Fax (+61 2) 9858 9889 | CHI.ORG.AU | [email protected] g Eastwood Train Stn To Carlingford Rd To Victoria Rd CHI Eastwood WE ARE HERE WE ARE HERE CHI Norwest CHI Macquarie Bus Stop H t on e t S e Av e nu ay ng Rd Rd i rk Pa s rk Pa ge or D Ge rk Pa g To es W d el tfi ll -A ng ay D in rk Pa ll d Rd Ki -A To e k Westfield Shopping Centre Rd s ud Th nu el r Pa es t H Q e Av t Fo r Bus Stop Rd e ue S e S Rd tfi es W a ns un rk Pa ee Qu Th or D ing ns n so ud m 3p til on W ra io Hu d R rst Orm ond e Pd e vill eS tn CHI Hurstville