Referral form | LiCOMS

Patient referrals

This section is for medical and dental practitioners to upload referrals for LiCOMS (Dr Tocaciu)

Please note that referrals to visiting surgeons are via their primary rooms.

Doctor First Name

Doctor Last Name

Provider Number

Phone

Email Address

Clinic/Unit/Hospital

Upload referral letter with patient information and contact details.

Upload Referral Letter

Upload supported file (Max 15MB). Please note incomplete referrals cannot be processed. Patients should be advised to contact the clinic after the referral has been received to confirm an appointment.

By uploading this referral, I confirm that: The referral contains all relevant clinical information required for the receiving clinician to provide safe and appropriate care. I have included sufficient patient identifiers, clinical history, current medications, allergies, investigation results, and the specific question or reason for referral to enable continuity of care. Upon the patient being seen by the receiving clinician/practice, duty of care for the referred condition transfers to the receiving clinician from the point of consultation onwards. I remain available for any clarification or additional information if required.

Thank you for submitting your referral.Please advise your patient to contact the clinic to confirm an appointment. If the referral is urgent, please contact the clinic or surgeon directly to discuss.

Research and publications

Research and publications

Patient referrals