Dr. Cliona Maguire
MB, BCh, BAO, MRCPI, FRACP
Dr. Rebecca Ryan
BMBS (Hons), FRACP
Dr. Terrence Tan
MBBS, FRACP, PhD
Dr. Mark Norrie
B.H.B, MB ChB, FRACP, PhD
	Dr Hadi Moattar
MBBS, FRACP
Dr Neal Martin
BSc, MBBS, FRACP
Dr John Wong 
MBBS (Hons), FRACP
Dr Ali Zad 
MD, FRACP
	
Patient’s Name:  <<Patient Demographics:Full Name>> D.O.B: <<Patient Demographics:DOB>>
Contact Number:(P)<<Patient Demographics:Phone (Home)>> (M) <<Patient Demographics:Phone (Mobile)>>
Address:  <<Patient Demographics:Full Address>>  	
Appointment type
	
[<<Consultation>>] Consultation
[<<Gastroscopy>> ]Gastroscopy	
[<<Telehealth>> ]Telehealth
[<<Colonoscopy>> ]Colonoscopy	

Colonoscopy patients will need to sit a compulsory appointment at least 4 days prior to their procedure to collect the preparation solution and instructions
	
Clinical Notes:<<Clinical Notes>>

	
Is patient on:<<Is patient on:>>

Patient BMI: 
<<Patient BMI>>	

Referring
Doctor’s Details :<<Doctor:Full Details>>

Provider no:<<Doctor:Provider Number>>

Signature: 
	
Date:<<Miscellaneous:Date (long)>>	
Phone: 07 3833 6701 GP Hotline: 07 3833 6788
Fax: 07 3833 6740 Email: bookings@montserrat.com.au	

www.montserrat.com.au	
[ <<Taringa,>> ] 32 Morrow St,
Taringa, 4068	[ <<Gaythorne>> ] 383 - 391 Samford Rd
Gaythorne Q 4051	 [<<North Lakes>>  ] 7 Endeavour Boulevard
North Lakes Q 4509	

Electronic Referrals can be sent via Medical Objects to provider number: CM40 0000 07H

v0.1

Taring
32 Morrow St
Taringa Q 4068

    Samford Road
383-391 Samford Rd
Gaythorne Q 4051

North Lakes
7 Endeavour Boulevard 
North Lakes Q 4509
 (next to OzCare)

Montserrat Gastroenterology 

Phone: 07 3833 6701 Fax: 07 3833 6740
	Operating at