PATIENT'S DETAILS
Preferred Doctor
First Available Doctor
Dr Keagan Werner-Gibbings
Preferred Clinic
Any Location
Chatswood
Dee Why
REQUEST
Consultation
Other, please specify below
COLOUR DUPLEX ULTRASOUND REQUEST
LOW EXTREMITY
Arterial L
Arterial R
DVT L
DVT R
Varicose Veins/Incompetence L
Varicose Veins/Incompetence R
UPPER EXTREMITY
Venous L
Venous R
Arterial L
Arterial R
Thoracic Outlet L
Thoracic Outlet R
ABDOMEN
Renal/Mesenteric Vessels
AAA Assessment/AAA Repair
Pelvic/Gonadal Vein Incompetence
IVC & lliac Veins
CEREBROVASCULAR
Carotid
Transcranial
CLINICAL DETAILS
Referring Doctor
Urgent Appointment
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