Referral Upload

All new patients are required to submit their referral prior to booking an appointment.

If you have a paper copy of your referral, the process of uploading this to us is better done using a smart phone.

Before completing this page, please use your smart phone to take photos of each page of your referral.

Once complete, return to this page, tap on 'Next' at the bottom and complete your contact details. Tap 'Browse' to select the photos of your referral that you have just taken and then tap 'Submit'.

Please ensure that you wait until the upload is complete before you switch to another application or turn off your mobile device.

This form can be completed on your desktop / laptop if you already have a digital copy of your referral on the relevant device.

Once you have uploaded your referral and it has been processed by us, you will receive an email with further instructions to book your appointment.

If you have not received an email or call from us within 72 hours, please call us on 03 8595 4288.

Contact Details

Do you already have an appointment at Melbourne Skin & Dermatology? *

YesNo

Have you ever been a patient at Melbourne Skin & Dermatology? *

YesNo

When were you last seen? *

Which dermatologist have you previously seen? *

Referral Upload (select all required pages) *

Browse

Is your referral password protected? *

YesNo

Please enter password/PIN for your referral *

2024 FEE SCHEDULE

	Non-concession	Concession	Medicare Rebate with a valid referral from a doctor
Initial Consultation	$365	$345	$81.30
Subsequent Consultation	$295	$275	$40.85
Review Skin Check	$335	$325	$40.85

If you are under 18 years of age, consent must be signed by a Parent/Guardian.

IN-ROOM PROCEDURE FEES

Should you require a procedure during your consultation, an additional out-of-pocket fee will apply. This can range from $50 - $750 depending on the complexity of the procedure.

The fee for a single standard biopsy ranges from $205 - $225 out of pocket.

As an example of a fee, if you were to have an initial consultation and a single biopsy;

the concession fee would be $580.00 with a medicare rebate of $125.45. This would leave you out of pocket $454.55
the non-concession fee would be $610.00 with a medicare rebate of $125.45. This would leave you out of pocket $484.55.

If you require more than one lesion or area biopsied, further fees apply.

CORTISONE INJECTIONS

Some conditions require treatment with cortisone injections. Should you require cortisone injections during your consultation, an additional fee of $230 applies. If you have a valid referral and Medicare card, you will receive a Medicare rebate of $39.45.

PATHOLOGY SERVICES

Please note that if you do not have a valid Medicare card, you will not receive any Medicare rebates and will incur additional charges from a pathology provider if tests are conducted for your consultation.

I have read and understood the privacy policy *

I agree to be contacted by Melbourne Skin & Dermatology using the contact details provided *

I understand that I will need to monitor my email account for further instructions to book my appointment. *

I understand that I will need to call the practice on 03 8595 4288 if I have not received an email or call from Melbourne Skin & Dermatology within 72 hours. *

Triage Status

Password required - ask to resendDeclined Referral

Reason for decline *

Other *

Comments

I confirm that a Genie file has been created for this patient and that the referral has been uploaded to the clinical file. (Note that once this step is completed, the patient will automatically receive an email to call us to book their appointment). *

Initials of staff member completing this step *