New or Updated Practitioner

(02) 6254 0271
(02) 8003 9228

admin@kippaxmedicalimaging.com.au
Suite 7, 76-80 Hardwick Crescent, Holt 2615

Serving patients and Saving their lives in all diagnostic medical imaging needs on their journey to complete healing and good health through Serving referrer with swift results and Saving the cost. | A Service with a Smile and excellence “Your health and healing begins with us”

New Practitioner Details

Title*
Name*
First Last
Provider Number*
Specialty
Practitioner Email*
Practice Phone Number*
If this is a new practice, please complete the 'New Practice Details form'

Results options.
Healthlink ID (For results into your practice management system)
Online Access
- Please send me online access details for images and results
Practitioner Email - For Online Credentials

This is where we will send the account details to:
Patient Delay
- None - Patient to receive results when available
- 24 Hours - Results delayed to the patient by 24 hours
- 48 Hours - Results delayed to the patient by 48 hours
*Note: This does not delay the referring practitioner from getting results
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(02) 6254 0271

(02) 8003 9228

admin@kippaxmedicalimaging.com.au

Suite 7, 76-80 Hardwick Crescent, Holt 2615

New Practitioner Details

Results options.