Order a Diagnostic Test

Fastest for eligible tests Book directly on HotDoc Holter monitor, Event Monitor, Heart Bug, 24hr BP Monitor and Echocardiogram can be booked online, one test at a time.

For referrals and grouped requests Use this order form Request several investigations together, upload documents, or send an existing referral.

Not sure which monitor to order? See our monitor selection guide →

Complete the form below to request one or more diagnostic tests for the same patient. Alternatively, fax a referral/request to (03) 5292 9300 or email info@pulsecardiology.com.au. Patients, if you are filling in this form you will require a referral from your GP or Specialist to claim a Medicare Rebate on the test.

Please Choose Tests to Order

Select all investigations required; multiple tests can be included in the same request.

Tests Selected *

Select one or more tests above.

OOP = out of pocket cost after Medicare rebate

Clinical details / indication *

Patient Details

Patient first name *

Patient last name *

Patient date of birth *

Patient phone *

Patient email

Requesting Doctor

Requesting doctor first name *

Requesting doctor last name *

Requesting practice name *

Requesting doctor provider number *

Requesting doctor phone *

Requesting doctor fax

Requesting doctor email

Providing your email allows us to contact you directly about this order.

Attachments

Upload File (referral letter, ECG, or other document)

Accepted: PDF, JPG, PNG, Word. Max 4 MB.

Your request will be sent to info@pulsecardiology.com.au