Greenslopes Specialist Centre,
Unit 20/121 Newdegate St, Greenslopes QLD 4120
Phone

07 3852 1406

Fax

07 3852 1407
Email admin@drbalakrishnan.com.au

Referrals

Make a referral
Thank you for choosing to refer your patient to Dr Balakrishnan, please submit an online referral form or email/fax it.

Email: admin@drbalakrishnan.com.au

Fax: 07 38521407

Patient First Name *

Patient Surname *

Date of Birth *

Contact Number *

Address

Clinical Information

Provider Full Name *

Provider Number *

Provider Contact Number *

Provider Clinic Name/Address

Attach Referral (optional)

Thankyou for your submission, we'll be in contact with the patient as soon as possible.

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New Patient & Referrals

Submit your referral and complete the New Patient Form

to secure your appointment.

Subash Balakrishnan | Website designed for private practice by Bay Medical Specialists