Request Form

Southern Nuclear Imaging are standardising their Nuclear Medicine/BMD Request Forms.

PRE-PRINTED options will be: 

A4 Single sided (large blank area with small header on one side) for printing from your computer.      

Please add your local SNIG Nuclear Imaging site to your service provider/address book or contact list. For address and contact details go to "Locations" in this Web Site or

A5 (personalised for the referring doctor if requested) handwritten forms (in a small pad).

Some practitioners prefer to simply use blank A4 paper. 

Two Location specific SOUTHERN NUCLEAR IMAGING options are available. They are:

  • Canterbury Bankstown Nuclear Imaging BANKSTOWN and REVESBY or
  • Illawarra Nuclear Imaging (Smith Street and Wollongong Private Hospital)/ Shoalhaven Nuclear Imaging (Standish Medical Centre)

Your forms will be dispatched within a day or two of us receiving your request.

An electronic A4 form is available. It is an .rtf file which can be auto-populated  (e.g. patient and Drs details; scan type and reason) from Medical Director, Best Practice and other PMS. Choose our template in your Letter Writer so that you can also provide location, preparation and related inforation.

 Do you need more forms? Please call 1300 136015
or go to the "Contact Us" page on this web site and fill in the Contact Us form

Need HELP?

Call Gary, your SNIG Clinical Liaison on 0418 763528 or email on .