Referral process and form

How to choose Epworth for your endometriosis care

Would you like to self-refer?

You can self-refer to have an appointment with one of our endometriosis nurse coordinators.

• Step1:: Download and complete the fillable referral and consent form.
• Step 2: Email your completed form to [email protected].
• Step 3: Our team will contact you to book a 1-hour telehealth appointment with the nurse.
• Step 4: At your appointment, the nurse will create a care plan with you and write a letter to your chosen Epworth Endometriosis specialist.
• Step 5: You can access ongoing support from the Endometriosis nurse coordinator once you have seen an Epworth endometriosis specialist.

If you would like to see an Epworth endometriosis specialist and do not want to access our Endometriosis nurse coordinator service first you can find more information about our specialists here.

Are you a healthcare professional who wants to refer your patient?

• Step 1: Download and complete this referral and consent form – only complete the referral form section.
• Step 2: Email the form to [email protected]
• Step 3: Our team will contact your patient to book an appointment and ask them to complete the consent form.

Any questions?

Contact the team on 03 9516 2434 or email [email protected]