Order/download request forms
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 firstname.lastname@example.org
Download or order request forms
To download a once-off copy of our request forms, simply click on the links below.
- General imaging - A4
- General imaging - A5
- Dental imaging - A5
- Chiropractor imaging - A5
- PET imaging - A4
- Urology imaging - A5
- Gynaecology imaging - A5
If you would like to order new request forms, simply complete the form below
Editable e-request (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 PDF 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.