Thank you for placing an online booking request, this is not a confirmed booking as yet, however our friendly and helpful support staff will promptly contact you to confirm your booking or to offer you the next closest alternative booking time. Thank you & please call (03) 9466 4122 if you require any kind of support. All fields marked with an asterisk (*) are required. Name* Date of Birth* Gender* GenderFemaleMale Contact Number* Additional Contact Number E-mail* Desired Specialist* ---Urologist - Dr Yee ChanEndocrinologist - Professor Karin Jandeleit-DahmEndocrinologist - Professor Mark CooperEndocrinologist - Dr Zemin CaoRheumatologist - Dr Indi RasaratnamCardiology - Dr Chris LimCardiology - Dr Anavekar Message Scan Referral Form (Only files in format PDF, JPG and JPEG are accepted) Emailinfo@www.thomastownconsulting.com.auPhone(03) 9466 4122Fax(03) 9005 2999Address113 High Street, Thomastown, VIC 3074