Updated Consultation Pricing: Now only $49 for all initial and follow-up consultations!
*Excludes Paediatric/Specialist consultations

CannaPlus+
Referrals

Our referral form

Referral form for doctors to submit a referral to CannaPlus+.

Date

Patient Name

Date of Birth

Email (Patient)

Contact Number (Patient)

Referring Doctor

Practice name

Contact Number (Doctor)

Email (Doctor)

Primary Diagnosis

Reason for Referral

Please ensure that all information provided in this form is correct and up to date