A breath of fresh air
is all you need
Always striving for quality
care and outcomes
Helping you with
every breath
Lung Health is our
Expertise
Breathe Freely,
Enjoy life
Lung Health is our
Expertise
Value lung health,
we do!

Lung Function and Allergy Testing Request Form

Please complete this form in its entirety, and send to us. The form can be either completed online and sent electronically, or downloaded and printed out for manual completion and returned to The Lung Health Clinic by email, post or fax to The Lung Health Clinic.

* Please note that all information transmitted to our clinic via the website is encrypted and a dedicated email address is used to receive electronic communications.

To download this form for manual completion, please click here.

Fields marked with an * are required

PATIENT DETAILS
Address

TESTS REQUESTED

CLINICAL DETAILS/REASON FOR REQUEST

REFERRING DOCTOR DETAILS/STAMP
Address

Send directly to the Lung Health Clinic by clicking SEND