Sending e-Referrals with Western Radiology is simple.

Online e-Referral Form


Which referral forms are valid?

Remember, you can send us a copy of a referral generated by your computer as part of your normal referring process (just fax or email a copy over).
Email to: bookings@westernradiology.com.au
Fax to: 9200 2778

You can download our editable A5 referral form or A4 referral form.
If you have your own template and are referring on plain paper, that’s fine too. All referrals are accepted at Western Radiology.

Don’t have access to any of these? Refer via our online e-Referral form

Urgent Appointments

Is your referral for something urgent? Do not refer here, please call 9200 2777 so we can expedite your patient’s care.


Download your editable A5 Cardiac CT referral form or editable A5 Cardiac MRI referral form.

Please complete the following form to submit your e-Referral:

    Referrer Details

    Patient Details

    Service Locations


    275 Wanneroo Rd, Balcatta WA 6021, Australia

    (08) 9200 2777

    Canning Vale

    1/410 Ranford Rd, Canning Vale WA 6155, Australia

    (08) 9200 2777


    1/278 Stirling Hwy, Claremont WA 6010, Australia

    (08) 9200 2777


    10/61 Key Largo Drive, Clarkson WA 6030, Australia

    (08) 9200 2777

    Cockburn Central

    2/810 North Lake Road, Cockburn Central WA 6164, Australia

    (08) 9200 2777


    1/210 Wanneroo Rd, Madeley WA 6065, Australia

    (08) 9200 2777


    73-77 Reserve Dr, Mandurah WA 6210, Australia

    (08) 9200 2777


    133 Russell St, Morley WA 6062, Australia

    (08) 9200 2777