Request a Test Referral Please complete the below and our team will email you a copy of your test referral. Need some help? Click here to contact us, we will be happy to help. Patient name*Date of birth* Date Format: DD slash MM slash YYYY Who is your doctor?Please selectA/Prof Nirmal PatelDr Leo PangDr Justin KongDr Fiona TingTest results requested*Please selectBloodsCT Head and NeckCT SinusCT Temporal BonesHearing and/or balanceMRIOtherPlease detail 'other'*Phone number to call*GP's Name*GP's Email address Email communications* I agree to receive email communications from The Sydney Hills ENT Clinic and it's associated entities and grant them permission to share my medical results/information with the GP detailed above. This iframe contains the logic required to handle Ajax powered Gravity Forms.