Referral Form

Dr Jingyi Cao

FRACS, MPhil (Med), MBBS, BMedSci — Head and Neck Surgeon, Surgical Oncologist, & General Surgeon

The SAN Clinic · Suite 301, 185 Fox Valley Road, Wahroonga NSW 2076 · Parking at P2

Phone: 1300 986 926 · Fax: 02 8088 7986 · Email: surgery@drcao.com.au · Healthlink: specserv

Patient Details

Patient full name

Date of birth

Medicare number

Phone

Referrer Details

Referrer full name

Practice / organisation

Provider number

Phone

Fax

Clinical Question

Please include relevant history, examination findings, imaging results, pathology reports, and the reason for referral.

Urgency

Routine Urgent (suspected cancer, rapidly growing mass, airway compromise, or other time-critical condition)

Referrer signature

Date

Send the completed form by fax to 02 8088 7986, email to surgery@drcao.com.au, or via Healthlink to specserv. Please mark urgent referrals URGENT and call our rooms on 1300 986 926 to confirm receipt.