Help using online Referral Form

To activate the online referral form, click the link (you will need at least Adobe Acrobat Reader 7). Acrobat Reader 7 is free software which may be downloaded from Adobe.

The form may be completed online and submitted by email, or printed off and completed by hand offline.

To complete and submit ONLINE:

  1. Open form by clicking on the link.
  2. Complete all known patient information by clicking on check boxes or typing into form.
  3. Check all information is correct.
  4. If you wish to save a copy for your files, select "Save As" from the "File" menu.
  5. Once ready to send referral form, click the "Submit" button. A new email message will open in your default email service (eg Outlook) with the form as an attachment.
  6. Add a message in the body of the email, including your name and contact details.
  7. Send email.
  8. To send the referral form using a web-based email server (eg hotmail, yahoo) you will firstly need to save the referral form by selecting "Save As" from the "File" menu.
  9. Open your web-based email account and create a new message.
  10. Attach the completed referral form to the email.
  11. Include your name and contact details in the body of the email and send to: info@anzrag.com.

To complete and submit OFFLINE:

  1. Open the referral form by clicking the link.
  2. From the "File" menu, select the "Print" option.
  3. Print the blank form to complete by hand.
  4. Submit the referral by fax to: 08 8404 2035 or through the mail to:
    • Australian and New Zealand Registry of Advanced Glaucoma
    • Dept of Ophthalmology, Flinders Medical Centre
    • Flinders Dve
    • Bedford Park SA 5042.
  5. Please feel free to keep your copy for your records.