Reflux Testing

Patient Referral Form

> BEFORE YOU PROCEED <

Before completing the form, we need to check for any urgent symptoms that may require medical attention.


Have you experienced any of the following symptoms recently?

🔴 Blood in your stool

🔴 Unintentional weight loss

🔴 Problems swallowing

🔴 A sudden and persistent change in bowel habits (pooing more or less)

🔴 A sudden and persistent change in stool consistency (harder or softer)

🔴 Vomiting blood

🔴 New lumps or growths

Based on your response, we strongly recommend consulting your GP before booking a reflux test.
However, if your GP has advised you to test for reflux, you’ re welcome to continue.

Click the button to proceed:

Please fill out this form and we will contact you to schedule your reflux testing appointment

How will you be paying for the tests?*

Your nearest clinic?

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