Home / For GPs / Refer a patient

Refer a patient

Complete the form below and we’ll contact the patient to arrange their Home Medicines Review. Please record the referral in the patient’s chart.

Referring practitioner

GP name *This field is required.

Provider number *This field is required.

Practice name *This field is required.

Practice email *This field is required.

Practice phone

Patient details

Patient full name *This field is required.

Date of birth *This field is required.

Patient phone *This field is required.

Suburb *This field is required.

Preferred language

Card type

Clinical information

Reason for referral *This field is required.

I confirm the patient meets the HMR eligibility criteria and the referral is recorded in their chart. *This field is required.

The patient has consented to the referral and to being contacted. *This field is required.

Referral details are encrypted and only visible to our clinical team. Prefer to send a referral letter? Email info@medreviewsmmr.com.au.