Referral Form

AGE RANGES & CONTRAINDICATIONS
Metabolism Scan & Substrate Analysis - Must be minimum 6YO+ & 10kg+ OR any age but 15kg+
BI-Spectroscopy - Must be 17YO+ and no electrical implants e.g. pacemaker
DEXA - All ages. Contraindicated in pregnancy.
TBNA (total body nutrition assessment) - This involves all of the above scans
REFERRER INFO
We will call the patient to organise their procedure. You will receive the results report within 48 hours post procedure either via Medical Objects or the email you provide below. Scans are clinically accurate, safe, painless and quick. They do not require you to remove clothing or exercise. Our metabolism scan is a breath test using a mask. BI-Spectroscopy involves 2 electrodes on each of your wrists/ankles. If safe to do so, 4 hours of avoiding food, exercise, caffeine/nicotine is required for both Metabolism Scan and TBNA (we will inform the patient of the procedure preparation). DEXA utilises a small amount of ionising radiation that is recognised as very safe (exposure is up to 50 times less than a chest xray and less than a domestic flight). For clinical guidance and results interpretation guides, please contact us on info@mntdiagnostics.com.au
DIETITIAN SUBSIDISED PRICE ACCESS
Patients are eligible for subsidised prices if they are provided with an official referral from an Accredited Practising Dietitian. This must be either using a provided MNT referral pad or using this E-referral form. Without a referral, the patient will not be eligible for subsidy and will pay the full amount.


By submitting this form you confirm that you have gained the patients consent to share information via an online form and have informed them that we will be in contact with them for booking.