Patient Referral Form | Dr Irina Baimatova

Publications
Presentations

About
Conditions Treated
For Patients
For Referrers
Contact

Select Page

Patient Referral

Contact INformation

Monday to Friday (9am – 5pm)
admin@drbaimatova.com.au
08 6333 2866
08 9467 6227
Health Link: ibaimato

Patient Details

First Name *

Last Name

Date of Birth *

Phone Number

Email Address *

Parent/Guardian if patient under 18

Reason(s) for Referral

Urgent Appointment Requested *YesNo

Things to discuss *Vericose VeinsAortic AneurysmsPeripheral Artery DiseaseCarotid Artery DiseaseFistulaPathologyOther

Clinical Details

Imaging

Imaging Types Available/RequestedUltrasoundMRIDopler

Imaging StatusAttachedWith PatientTo FollowOnline Access

Upload Imaging if Available

Drag and Drop (or) Choose Files

Practitioner Details

Referring Doctor *

Provider number *

Practice Name *

Practice Email

Practice Phone Number

Referral and other documents

Drag and Drop (or) Choose Files

Signature of Referring Doctor

Start signing your signature here

Memberships and Affiliations

Dr Baimatova’s Professional Network and Memberships

Hollywood Medical Centre

Consultations

Google Location
Directions

St John of God Midland Public Hospitals

Consultations

Google Location
Directions

Quick links

Dr Irina Baimatova
Make an Appointment
Refer a Patient
Conditions Treated
Consulting Locations
Frequently Asked Questions

Contact Us

Monday to Friday (9am – 5pm)
admin@drbaimatova.com.au
08 6333 2866
08 9467 6227
Health Link: ibaimato

© 2026 All rights reserved

Privacy Information | Terms and Conditions | Feedback

Dr Irina Baimatova, a leading vascular surgeon, offers cutting-edge treatments, leveraging her expertise to deliver exceptional vascular care, incorporating the latest methodologies for optimal patient outcomes.

Privacy Information | Terms and Conditions | My Webguy

Dr. Irina Baimatova - © 2026 All rights reserved

Dr Irina Baimatova, a leading vascular surgeon, offers cutting-edge treatments, leveraging her expertise to deliver exceptional vascular care, incorporating the latest methodologies for optimal patient outcomes.