GP Referrals | RTS

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Tel: 08 9331 6371

Fax: 08 9337 2284

GP CLINICAL LUNG FUNCTION REFERRAL FORM 2025

Request Date*

General Practice Name*

Practice Address

Requesting GP*

Provider No

Patient Full Name*

Patient DOB*

Day

Month

Year

Patient Phone / Mobile*

Patient Address*

Patient Medicare Number*

Gender

Female

Male

Undisclosed

Urgent Results (within a week)

Recent HB (<3 months)

Clinical Tests*

Full Lung Function (PFT)

Full Lung Function With Inspiratory Loop

Fraction Of Expired Nitric Oxide Analysis (FENO)

Spirometry

Bronchial Provocation (MANNITOL)

6 Minute Walk Test (6MWT)

Respiratory Muscle Strength

Altitude Simulation

Pre-existing Conditions*

Asthma

COPD

Interstitial lung disease

Bronchiectasis

Cystic fibrosis

Pulmonary hypertension

Asbestosis

Silicosis

None

Preferred RTS location

O'Connor

Carine

Midland

Armadale

Albany

Narrogin

Bunbury

Busselton

Katanning

Denmark

Rockingham

Clinical Notes

File upload

Results Email*

Call

(08) 9331 6371

Email

info@respiratorytesting.com.au

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