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Online imaging requests

E-referrals (direct from clinical software)

If your clinic uses Best Practice, MedicalDirector, Genie or Zedmed you can send us e-referrals direct from your software to ours.

If you would like to activate the use of e-referrals, simply contact us at marketing@bensonradiology.com.au

Online referral form (for referring practitioners only)

Upon receipt of this referral, a member of our team will contact your patient directly to arrange an appointment at the most suitable clinic location.

Please note that referrals for public patients from public hospital providers must be submitted through the SAMI Private Provider Panel. Referrers utilising Rights of Private Practice (ROPP) should indicate this at the time of referral.

Patient details

10 characters left

Please list the number we can most easily contact the patient on

Patient address

Examination and clinical: *

Is this clinically urgent? 

For CT patients:

CT intervention +/- CT scan

Referring practitioner details

8 characters left
Referring Address
Cc doctor: 
8 characters left

Signature

Disclaimer

I confirm that I am a practicing clinician and, to the best of my knowledge, have the legal authority to request this medical imaging examination.

Disclaimer acknowledgement 
10 characters left
Your browser does not support the Signature field

Editable National Lung Cancer Screening Program (NLCSP) Low-dose CT request-form (referrers only)

If you don’t have a request form on hand, simply complete one online via this editable PDF. Click the submit button on the form and we’ll do the rest.

Please note: the editable PDFs must be downloaded (right click on the link and then click "save target as" or "save link as") and viewed using Adobe Acrobat 8.x or newer. Please digitally sign and date before submitting to Benson Radiology. It will not function correctly if it's opened directly within the browser.