Direct Access Endoscopy

Please fill out the online form below. If you would prefer to complete offline please click the button below to download a PDF version.

Once complete please send a copy to – [email protected] or fax to 08 8359 2477

 

OPEN REFERAL FORM

 

PATIENT DETAILS

For suitable patients (without prior specialist consultation)

PROCEDURE REQUESTED

REASON FOR PROCEDURE

MEDICAL HISTORY

REFERRAL

PATIENT DETAILS

  • Are under 80 years of age

  • Able and willing to consent in English

  • Are fit and healthy

  • Have a current referral

  • Are not taking anticoagulant or blood thinning medication, aside from aspirin

  • Have no history of heart disease, obesity, diabetes, stroke, epilepsy, kidney or liver disease, or serious lung disease

  • Have somebody to transport them to and from the hospital

  • Have private health insurance or wish to have their colonoscopy in a private hospital

  • Note – if patients do not fulfill these criteria, they will need a consultation with Dr Balalis prior to their procedure

PROCEDURE

  • Send Direct Access Procedure Formonline, or via email, fax or post

  • Each Referral will be reviewed by Dr Balalis to confirm suitability

  • Patients will then be contacted by the practice to arrange a convenient time for the procedure and answer any questions

  • Any patient considered unsuitable for Direct Access will be offered an appointment to see Dr Balalis

  • Bowel Preparation Instructions - will be organised on discussion with Dr Balalis.

DAY OF THE PROCEDURE

  • Patients will arrive at the hospital day procedure area

  • Dr Balalis will meet with the patient to review their history, discuss the procedure and gain informed consent

  • The procedure will be performed, with an anaesthetist administering the sedation

  • The results of the procedure will be discussed with the patient on the day, and a report sent to the referring doctor