Medical Referral Form

Referrals from a specialist or GP should be addressed to –

Dr Ruvi Samarasekera

Clinical Geneticist

First Light Genetics

Please send the referral to the practice via email reception@firstlightgenetics.com.au

OR alternatively, fax it to 02 9054 0166.

Medical records and results relevant to the referral are essential.

    Patient Details

    Service Required

    Indication for referral

    Family History

    Referring Doctor's Details