Referral Form Please Note: Dr. Paul Smedley is no longer practicing. He has had to retire early on medical grounds. * RequiredName of the Clinician / Clinic / Contact Person* Email Address* Phone Number* Patient's Name* Patient's Date of Birth NHI number Patient's AddressPatient's Contact Number/s* Patient's Email Address Patient's Preferred Method of Contact Home Phone Cell Phone Email Comments and reason for patient referral.Please attach any relevant files or fax to 09 486 0159 Drop files here or Select files Accepted file types: pdf, doc, docx, png, jpg, Max. file size: 256 MB.