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Bulk-Billed Echocardiogram/ECG Only Request Form

Patient's Name *

Date of birth *

Gender *

Female
Male
Other

Address

Parent's/Guardian's Name *

Parent's/Guardian's Email Address

Parent's/Guardian's Phone *

Patient's Medicare Number *

Period Of Referral *

Indefinite
12 Months
3 Months

Referral For *

Echocardiogram Only (Bulk-Billed)
ECG Only (Bulk-Billed)
Echocardiogram + ECG Only (Bulk-Billed)

Clinical Details *

Referring Doctor *

Clinic Name and Address

Date of referral *

Provider Number *

Note

Call: 08 7081 9819

Email: Our reception

Directions: Google Maps

College Park

(All doctors)

25 Payneham Road College Park SA 5069

Phone: 08 7081 9819
Email: reception@sapan.health
Fax: 08 7093 0404

Ashford (Dr Sinhal)

Suite 31, Level 4
Ashford Specialist Centre
57/59 Anzac Highway
Ashford SA 5035, Australia

Phone: 0433 323 163
Email: reception.sinhal@gmail.com
Fax: 08 8371 1041

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© Copyright 2023 SA Paediatrics and Newborns (SAPAN)

Notice to Our Patients

Consultation Fee Update: From 1 October 2026, SAPAN will introduce a service fee to support the continued delivery and enhancement of the high-quality care and services we provide to our patients.

We sincerely appreciate your understanding and ongoing support. If you have any questions, our friendly reception team will be pleased to assist.