Author: Michael Porter

VASCULAR IMAGING
VASCULAR CONSULTING

Dr Steve Baker | Dr Rick Bond | Prof Patrice Mwipatayi |

For All Appointments & Reports 	P: 1300 887 997 	E: adminteam@cvs.net.au

Patient Name: | <PtFullName> | Date of Birth: | <PtDoB>
Address: | <PtStreet> <PtCity> <PtPostcode> <PtState>
Phone: | <PtPhoneH> | Mobile: | <PtPhoneMob>
Email: | <PtEmail>

Tests Required: <==TESTS REQUIRED==>

Arterial Ultrasound <==Arterial Ultrasound==>
1.    <Carotid Doppler> Carotid Doppler
2.    <AAA Study> AAA Study
3.    <*Peripheral Arterial Study> *Peripheral Arterial Study
4.    <Aorto-lIiac Artery Duplex> Aorto-lIiac Artery Duplex
5.    <Arterial Lower Limb> Arterial Lower Limb		<Arterial Lower - LEFT Limb> L	<Arterial Lower - RIGHT Limb> R
6.    <Arterial Upper Limb> Arterial Upper Limb		<Arterial Upper Limb - LEFT Limb> L	<Arterial Upper Limb - RIGHT Limb> R
7.    <Ankle Brachial lndex (ABl)> Ankle Brachial lndex (ABl)
8.    <Bypass Graft Surveillance Scan> Bypass Graft Surveillance Scan
	   Specify : <If Bypass Graft Surveillance Scan, specify:>
9.    <Renal Arteries> Renal Arteries
10.  <Mesenteric Artery Duplex> Mesenteric Artery Duplex

Venous Ultrasound
11.    <DVT> DVT 		<DVT - LEFT Limb> L 	<DVT - RIGHT Limb> R	Urgent <DVT - URGENT>
12.    <Iliac Vein Duplex> Iliac Vein Duplex
13.    <Venous Lower Limb> Venous Lower Limb		<Venous Lower Limb - LEFT Limb> L	<Venous Lower Limb - RIGHT Limb> R
14.    <Ovarian and Pelvic Veins> Ovarian and Pelvic Veins
15.    <Testicular and Pelvic Veins> Testicular and Pelvic Veins
16.    <Venous Upper Limb> Venous Upper Limb		<Venous Upper Limb - LEFT Limb> L	<Venous Upper Limb - RIGHT Limb> R
17.    <Vein Marking/Mapping> Vein Marking/Mapping
		Specify : <If Vein Marking/Mapping, specify:>
18.    <Arteriovenous Fistula> Arteriovenous Fistula
19.    <Renal Access Work Up> Renal Access Work Up

Vascular Consultation Required <==VASCULAR CONSULTATION REQUIRED==>
<Dr Steve Baker> Dr Steve Baker	P: 9310 1022 | <Prof Patrice Mwipatayi> Prof Patrice Mwipatayi	P: 9386 9588
<Dr Rick Bond> Dr Rick Bond		P: 6397 5120 |

Clinical Details / Medication | <Clinical Details / Medication>

Specific Clinical Query?
For any clinical queries regarding vascular ultrasound, including scan selection and interpretation of results, please email our vascular sonographer team at vascular@cvs.net.au for same-day response.

<Specific Clinical Query?>

Referring Doctor: | <DrName>
Referring Doctor's Signature: | | Date: | <TodaysDate>

* Note 	A Peripheral Arterial Study includes duplex scans of the abdominal, femoral, popliteal and tibial arteries.
	Depending on a patient’s condition and geographic location this will in most instances require more than one attendance.

Please send completed referral to CVS at admin@cvs.net.au to facilitate booking. 
Please bring this referral to your appointment.

Inglewood | | Joondalup | | Murdoch

Ground Floor, Unit A
826 Beaufort Street
Inglewood WA 6052

PARKING
Free parking available on side streets

Joondalup Health Campus
Specialist Medical Centre (West)
Suite 205, Level 2
Joondalup WA 6027

PARKING
P1 (Pay as you leave parking) - Enter via Shenton Ave
P4 (Pay and display parking) - Enter via Regents Park Rd
Some free street parking available on Regents Park Rd

Murdoch Square 
Suite 303/304, 
44 Barry Marshall Parade,
Murdoch WA 6150
PARKING
Paid parking onsite at Murdoch Square

Nedlands | | Midland | | Mandurah

CVS Testing Appointments: Suite 8
CVS Consultant Appointments: Suite 13
Hollywood Specialist Centre
95 Monash Avenue Nedlands WA 6009

PARKING
Park in multistorey carpark via
Entrance 5, Monash Avenue

Suite 2, Midland Professional Centre
9 The Avenue (Corner of Keane Street)
Midland WA 6056

PARKING
Paid parking available on side streets.
Several City of Swan parking facilities are available
off The Avenue, Kean Street, Old Great Northern Hwy
and Stafford Street.

Peel Health Campus
Suite 3, South Consult Suites
110 Lakes Road
Mandurah WA 6210

PARKING
Free parking onsite at
Peel Health Campus

Bunbury | | | |

Patient and testing information is available on the
‘For Patients’ pages of the website at cvs.net.au
or please call the CVS team on 1300 130 930
who will be happy to assist you with any queries.

Unit 2, 138 Spencer Street,
Bunbury WA 6230
Direct line: (08) 6389 3585
PARKING
Free parking onsite

P:	1300887997(8am-5pmMon-Fri)
F:	(08) 93895322
E:	adminteam@cvs.net.au
W:	cvs.net.au
Healthlink EDI: hollspec