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Skin Health Institute
Main Menu
For Health Professionals
Menu Toggle
Refer a Patient
Education
Menu Toggle
Education Events
Education Portal
Advanced Therapeutics Education Portal
Pathology
Patch Test Certificate
Spot Diagnosis Podcast
Research
Menu Toggle
Occupational Dermatology Research and Education Centre
Australasian Dermatology Registry
Contact Allergen Bank Australia
Publications and Presentations
Resources for Health Professionals
For Patients
Menu Toggle
Clinics and Specialist Services
Menu Toggle
Clinics
Find a Specialist
Patient Information
Menu Toggle
Contact
Open Disclosure
Patient Fees
Patient Rights and Responsibilities
Telehealth
Patient Resources
Menu Toggle
Skin Conditions
Healthy Skin Guide
Patient Support Groups
SHI Patient Payment Portal
Leave your feedback
Clinical Trials
Menu Toggle
ABOUT CLINICAL TRIALS
Current Trials
Menu Toggle
ACNE
ATOPIC DERMATITIS
HEALTHY VOLUNTEER CLINICAL TRIAL
HIDRADENITIS SUPPURATIVA RESEARCH STUDY
MELANOMA SURVEILLANCE and Non-Melanoma Skin Cancer Trials
PSORIASIS
General Information
Menu Toggle
Our Team
Testimonials
Ethics And Clinical Trial Governance
Contact Us
For Patients
For Clinicians
For Sponsors
About
Menu Toggle
Contact
Our History
Membership
Our Partners
Governance
Menu Toggle
SKIN HEALTH INSTITUTE CONSTITUTION
SKIN HEALTH INSTITUTE BOARD
Annual Reports and Financial Statements
Leadership Team
Clinical Governance
Affiliations
Work with Us
Support Us
Menu Toggle
Make a donation
Wills and bequests
Back to Occupational Dermatology Research and Education Centre
Patch Testing Referral Form
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Date of referral
Patient Name
*
First
Last
Patient email address
*
Date of birth
*
Address
*
Address Line 1
City
State / Province / Region
Postal Code
Phone number
*
Referring Dr:
*
Provider No:
*
Correspondence to:
*
Referring Dr Email
*
Interpreter/ Auslan required
*
No
Yes
Language
*
Clinic
*
Contact dermatology
Occupational dermatology
Occupation
*
Reason for Patch Testing referral
*
Medical History (including relevant medications):
*
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Attachments – referral/history/photos
*
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The cost of the consultations and patch testing is between
$750 and $950.
In some instances, it will be less than this but is dependent on the number of tests that will be applied.
A pre-payment of $450 is required for all patients Your appointment will only be confirmed once payment is received.
The Medicare rebate is approximately $220-$250. You will receive the rebate from Medicare a couple of days AFTER your FINAL appointment.
You will be required to complete a financial consent form prior to prepayment being made or before appointments are made.
You will be required to pay this pre-payment at the time of making appointments. Your appointment will only be confirmed when this payment is received. This payment can be made on the Skin Health Institute website patient payment portal: https://skinhealthinstitute.org.au/for-patients/shi-patient-payment-portal/ Alternatively, payment can be made over the phone via credit card, please call 03 9623 9402.
If payment is not received within 48 hours of this phone call, you will receive a text message, warning your appointment will be cancelled. If you do not make contact with us via email or phone call within one business day of receiving this text message, your appointments will be cancelled.
Please note this clinic is NOT a bulk billing clinic.
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Patient notified of deposit requirements
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