Referral Form

All fields are required

Name *

First

Last

Date of birth *

Gender *

Female
Male
Other

Address *

Medicare Number *

Medicare Reference No. *

Exp Date *

Referring Practitioner *

Clinic Name and Address

Practice Phone No. *

Referral is for:

Medical Problem
Developmental-Behavioural Problem
Allied Health (eg. Physiotherapy, OT, Speech, etc.)

PARENT | CARER’S DETAILS

(Nominated Account Holder | Person to Receive Medicare Rebates)

Parent Name *

First

Last

Relationship to Child

Mother
Father
Guardian

Phone Number

Email Address *

Upload Referral File

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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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.