You are here

Patient Referral

If you’d like to refer a patient to Dr Silverman for a consultation for general or bariatric surgery, or for further specialist support, please complete the following form and include as much information as possible.

Please note: items marked * indicate mandatory fields.

GP/Specialist details
Please enter phone number with area code included. No spaces please. eg. 0298765432
Patient details
Please enter phone number with area code included. No spaces please. eg. 0298765432
Document uploads
Provide up to five relevant documents (scanned referral, certificates etc).
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.