028 96 211 981
appointment@friendsmedicalservice.com
Home
About Us
About Us
Accreditations
DEXA
Ultrasound
Surgical Procedures
Other Services
Teleradiology
Consultants
Testimonials
Contact Us
Pick An Appointment Type
Book an appointment (Patient/Dexa)
Book an appointment (Patient/Surgical)
Practitioners Referral
Select Page
Practitioners Referral
Refer Scan
We aim to get back to all enquiries within 24 hours.
Practitioners Referral
Practitioner First Name
*
Practitioner Last Name
*
Practitioner registration No.
*
Additional Information
Patient First Name
*
Patient Last Name
*
H&C No.
Insurance Registration Number
Date of Birth
*
Contact Number
*
Clinical Information
Treatment Requested
Captcha
If you are human, leave this field blank.
Submit