1800 111 483

Alexandria	
Level 3
15 Bowden Street	

Bondi Junction	
16th Floor
Westfield Tower 2
101 Grafton Street	

Burwood	
Suite 202 Level 2
74-76 Burwood Road	

Castle Hill	
Suite 4
15-17 Terminus Street	

Dee Why	
Level 3
834 Pittwater Road	

Frenchs Forest	
Suite 1, Level 6
Northern Beaches Hospital
105 Frenchs Forest Rd West	

Gosford	
Level 2, Suite 24
207 North Albany Street	

Greenwich	
Level 2
176 Pacific Highway	

Kogarah	
Level 3
St George Private Hospital
South Street	

Miranda	
Suite 4
20-24 Gibbs Street	

Newcastle	
The Heights Private
Medical Centre
2 Lookout Road
New Lambton Heights	

Sydney CBD	
Level 1
33 York Street	

Wahroonga	
201 Parkway San Clinic
172 Fox Valley Road	

Westmead	
Level 2
20-22 Mons Road	

Wollongong	
Suite 1
21 Auburn Street	

Canberra	
Level 2
173 Strickland Crescent
Deakin	

ivf.com.au	

	Fertility Referral

To	
IVFAustralia FERTILITY SPECIALIST:
<Location/Fertility Specialist>	

Re: PATIENT NAME
<PtFullName>
DOB
<PtDoB>	

PARTNER NAME
<Partner's Name>
DOB
<Partner's DOB>

Reason for 
Referral / 
Notes	
<Reason for Referral/Notes>	

Requesting
Doctor	
<DrDetails>	

Provider No.	
<DrProviderNo>	

Signature	
	
Date	
<TodaysDate>	

Email referral to: info@ivf.com.au

To book your appointment, please call us on 1800 111 483	
IVFA101 02.03.2023