Wesley Urology Clinic | Suite 42, Level 4, Wesley Medical Centre, 40 Chasely St, Auchenflower
07 3720 6900
The form below should be completed by the referring doctor to generate a printable referral form for their patient.
Refer the patient to:
General Referral to Wesley Urology Clinic
Dr Geoff Coughlin - Prostate, bladder and kidney conditions
Dr Nigel Dunglison - Prostate, bladder and kidney conditions
Dr Rachel Esler - Prostate, bladder and kidney conditions
Dr John Yaxley - Prostate and bladder cancer
Patient's Phone Number
Patient's Date of Birth
Patient's Medicare Number
Doctor's Provider Number
Doctor's Phone Number
Remember these details?