Online Request Or Referral

This form (below) is designed to be a digital/online referral for use by health professionals either referring a patient (instead of a paper referral) or requesting GMI contact them or their patient. 

If you have a paper referral use the UPLOAD REFERRAL option below.

Online Referral Form

For Digital Referrals

If you need to upload a file(s)

By submitting this information you agree to our privacy policy. Your information will only be used for the purpose of making a booking and communicating with you and your patient/referrer. We will not release the information to a third party without your consent.