Refer Now Please enable JavaScript in your browser to complete this form.Patient Name *Date of Birth *Patient Contact Number *Patient Email *We provide comprehensive swallowing evaluation with the following diagnostic services: (please tick)Flexible Endoscopic Evaluation of Swallowing (FEES)Videofluoroscopy Swallow Study (VFSS) Download Radiology Referral Form HereLaryngopharyngeal Reflux (LPR) Testing - Oral Salivary Pepsin Mailout Kit (Peptest(R))Laryngopharyngeal Reflux (LPR) Testing - 24 hour dual probe pH/Impedance MonitoringTransnasal Oesophagoscopy (TNO)High Resolution Pharyngeal ManometryHigh Resolution Oesophageal ManometryConsultation with Swallow Assessment Team: ENT and Speech Pathologist (Includes Flexible Endoscopic Swallowing Evaluation)Biofeedback Swallowing TherapyDr Paul Paddle ENT Surgeon / Laryngologist Ms Claire Stanley Speech Pathologist Dr Anthony Rotman ENT Surgeon / Laryngologist Dr Christopher Schneider Functional Gastro-enterologist Level 1, 449 Swan St Richmond VIC AUSTRALIA 3121 Phone: +1300-952-808 admin@melbswallow.com.au Referral Details (include reason for referral) *Relevant Medical History *Current Medications (may prefer to attach list)Priority for appointment: *RoutineUrgent Name and contact details of referring agentReferrer NameProvider Number *Referrer Contact Number *Clinic Name and AddressFile Upload Click or drag files to this area to upload. You can upload up to 3 files. Upload any additional test results, medication lists or relevant information hereSignature * Clear Signature PhoneSubmit Download PDF
01.01.2024 Up your Dysphagia Game with MSAC Academy in 2024! Happy New Year! Is one of your New Year’s resolutions to increase your knowledge... More Info