Referring Your Clients to Knox Audiology

Over 30 years of Specialist audiology care across four Melbourne clinics.

Our audiologists hold a Master’s in Clinical Audiology and are
accredited members of Audiology Australia.

Online Referral Form

"*" indicates required fields

Select first, this determines which services are available in Section 3

Clinic*

Patient name*

Date of birth*

Address*

Postcode*

Phone*

Medicare no.

Ref no.

Medicare expiry

Service Requested*

Patient Symptoms

Proceed with further tests at the audiologist's discretion.

Leave unticked if you'd prefer we call before extending testing.

Provider no*

Date of birth*

Provider name / clinic*

Signature

Once completed please send by fax to:
Fax: 9887 5333 or via secure email: reception@knoxhearing.com.au

Care that’s close to home, with connected support across
Wantirna, Surrey Hills, Boronia and Doreen.

Our team is here to make the referral process
straightforward for you and your patients.