New Patient Referral

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Thank you for referring your patient to QLD Pelvic Floor Centre.

If you haven’t had a chance to get familiar with us, our team is comprised of experienced colorectal surgeons, a gastroenterologist, a urogynaecologist, a specialist nurse practitioner and highly experienced pelvic floor physiotherapists, all under the one roof, and committed to providing a holistic coordinated service.

Initial appointments, investigations (including anorectal physiology and urodynamic assessment if necessary) and conservative treatment with our nurse practitioner will be bulk-billed.

To refer your patient, please complete the following form, or alternatively email the referral to

If it’s easier, here’s a printable pdf version. You can email the referral to

If you would like a referral pad, please email with how many you’d like and your postal address.

Contact Options:

Office Hours:

Monday – Friday 0800 – 1700

Referral Submission Form

Referral Form

Patient Name(Required)
Patient DOB
Patient Symptoms

Referral For:

Assessment only (bulk billed)
Assessment with advice from Nurse Practitioner (bulk billed)
Assessment + Specialist Consultation (charges apply)
Referral for
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    We acknowledge the Traditional Owners of the lands where we live and work, and pay our respects to Elders past, present and emerging.


    Monday – Friday: 0800 – 1700