Joint Orthopaedic Centre Doctor's Referral Form

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Referral Letter
- Medical in confidence-

Joint Orthopaedic Centre

Lawrence Kohan Orthopaedic Surgeon
M.B., B.S. (Hons) F.R.A.C.S., F.A. Orth.A

All Appointments & Enquiries
Telephone: (02) 9387 5985 / 9387 2877

Postal Address
PO Box 240, Bondi Junction 1355

Level 2, 99 Spring Street
Bondi Junction NSW 2040
fax: (02) 9387 5557

32 Norton Street
Leichhardt NSW 2040
Tel: (02) 9560 8272

Website: http://www.jointreconstruction.com

Referring Practitioner Details		Practice address
Name
E-mail address
Telephone no.
Fax no.

History of presenting complaint / examination findings / investigation results

Reason for referral (including expectation of referral outcome)

Past medical history

Current and recent medication

Clinical warnings (eg allergies, blood-borne, viruses)

Smoking status Alcohol consumption

Additional relevant information (including patient's issues, social circumstances and special needs)