WESLEY MEDICAL CENTRE
Level 2, Suite 26, 40 Chasely St
AUCHENFLOWER Q 4066
Tel: (07) 3607 5190 Fax: (07) 3607 5196

ST ANDREW’S PLACE
Ground Floor, 33 North St
SPRING HILL Q 4000
Tel: (07) 3054 1228 Fax: (07) 3054 1229

IPSWICH MIKA HOUSE
Suite 2, Level 2, 3 Wharf St
IPSWICH Q 4305
Tel: (07) 3050 7102 Fax: (07) 3050 7103

GREATER SPRINGFIELD SPECIALIST SUITES
Level 5, Suite 503, Cnr Health Care Dr & Wellness Way
SPRINGFIELD CENTRAL Q 4300
Tel: (07) 3180 8290 Fax: (07) 3180 8291

ST VINCENT’S HOSPITAL
Entrance 3, Level 2, Scott St
TOOWOOMBA Q 4350
Tel: (07) 4646 4250 Fax: (07) 4646 4253

ST ANDREW'S HOSPITAL
Building 4, Level 1, Suite 31
280 North St
ROCKVILLE Q 4350
Tel: (07) 4592 8086 Fax: (07) 4592 8087

PINDARA PRIVATE HOSPITAL
Level 1 (Main Hospital)
39 Allchurch Ave
BENOWA Q 4217
Tel: (07) 5610 5812 Fax: (07) 5610 5813

GOLD COAST PRIVATE HOSPITAL
Level G, Specialist Suites, 14 Hill St SOUTHPORT Q 4215
Tel: (07) 5615 0005 Fax: (07) 5615 0006

ICON CANCER CENTRE
Level 1, 9 McLennan Court NORTH LAKES Q 4509
Tel: (07) 3607 5190 Fax: (07) 3607 5196

PULSE OCEANSIDE MEDICAL
Level 5, Suite 605
11 Eccles Boulevard
BIRTINYA Q 4575
Tel: (07) 5353 5166 Fax: (07) 5353 5167

ST STEPHEN’S HOSPITAL
1-11 Medical Place HERVEY BAY Q 4655
Tel: (07) 4313 1160 Fax: (07) 4313 1161

HERVEY BAY MAIN ST CLINIC
Suite 8, 62 Main St
PIALBA Q 4655
Tel: (07) 4313 1160 Fax: (07) 4313 1161

MATER MEDICAL SUITES
Wing 1, Suite 3, 313 Bourbong St
BUNDABERG Q 4670
Tel: (07) 4304 8001 Fax: (07) 4304 8002

MACKAY PRIVATE HOSPITAL
Suite 1, 57 Norris Road
MACKAY Q 4740
Tel: (07) 4805 6441 Fax: (07) 4805 6440

MATER PRIVATE HOSPITAL
Suite 1, Level 1, 31 Ward St
ROCKHAMPTON Q 4700
Tel: (07) 4807 6512 Fax: (07) 4807 6513

Respiratory Test Request

Test Bookings Tel: (07) 3607 5194
E: reception@qldrespiratory.com.au	www.qldrespiratory.com.au
Patient Details:
Surname: ............................................... First Name: ......................................... DOB: .........../.........../.............
Address: ..........................................................................................................
Home Ph: ............................ Work: ........................... Mobile: ..........................
Clinical History/Details:  ….......................................................................................
.........................................................................................................................
.........................................................................................................................
.........................................................................................................................
Investigation Required:
o	Complex Lung Function (flow volume loops, gas transfer, lung volumes)
○	With bronchodilator testing  ○ No bronchodilator testing
o	Spirometry/flow volume loops - before & after bronchodilator
o	Cardiopulmonary Exercise Test (Wesley)
o	Bronchial Provocation:
○	Mannitol  ○ Hypertonic Saline (Wesley)
o	Allergen Skin Prick Test (Wesley, Bundaberg, Hervey Bay, Toowoomba & Springfield)
o	Hypoxic Altitude Simulation Test (Wesley, Bundaberg & Hervey Bay)
o	Respiratory Muscle Strength (MIPS/MEPS & postural spirometry)
○	SNIP (SAWMH and Toowoomba StA)
o	Postural Spirometry (seated & supine)
o	6 Minute Walk Test (single trial without O2)
o	6 Minute Walk Test (dual trial without and with O2 for MASS evaluation)
o	Overnight Oximetry
o	FeNO - Fractional Exhaled Nitric Oxide (with spirometry)

Referring Doctor Details:
Doctor's Name: .........................................................................................
Address: ...................................................................................................
.................................................................................................................. Signature: ...................................... Provider No: .....................................
Date of Referral: ......./......./...........
Email/Fax: ................................................................................................
Invoice test to (patient/employer/Workcover etc.): ..................................
RSHQ Approved Spirometry Provider

Queensland Respiratory Services offer a full range of lung function and allergy testing in an accredited laboratory backed by the largest private respiratory
physician group in the state

Test Preparation
All Tests

Inhaler withholding times	
8 Hours	Asmol®, Bricanyl®, Ventolin ®, Zempreon®	
Ingestion of food containing caffeine should be withheld on the day of the test, as it can decrease bronchial hyper-responsiveness. Smoking and vigorous exercise should not be undertaken on the day of the test.

Bronchial Provocation

Inhaler withholding times	
4 Hours	Intal®, Tilade®	
8 Hours	Ventolin®, Asmol®, Bricanyl®	
12 Hours	Pulmicort®, Flixotide®, Fluticasone Cipla®, QVAR®, Alvesco®, Arnuity®, Atrovent®	
24 Hours	Foradile Theo-Dur®, Nuelin®	
36 Hours	Seretide®, Cipla®, Symbicort®, DuoResp®, Breo®, Flutiform ®, Serevent ®, Oxis®, Onbrez®	
3 Days	Spiriva®, Bretaris®, Incruse®, Seebri®, Brimica®, Anoro®, Ultibro®, Spiolto®, Trelegy®, Trimbow®	
4 Days	Singulair®	
Antihistamine withholding times	
3 Days	Avil®, Benadryl®, Claratyne®, Claramax®, Periactin®, Phenergan®, Polaramine®, Telfast®, Zyrtec®	
Cardiopulmonary Exercise Test
Day of test - avoid heavy meals, smoking and alcohol consumption.
Wear comfortable shoes and clothing for riding a bike.
On the day of the test report to Reception, Level 2, Suite 26 of the Wesley Medical Centre at the appointed time. A doctor will be present for the testing.
Allergen Skin Prick Test
72 hours before test - do not take antihistamines
Note: Mood stabilisers (e.g., Endep, Avanza) can cause a false negative test. Please inform staff when making your booking if you are taking prednisolone.
Respiratory and Sleep Specialists
To book appointments with a Respiratory Physician please call one of the numbers below.
Locations can be found at our website www.qldrespiratory.com.au

Dr Farzad Bashirzadeh	(07) 3871 0033	Dr Justin Hundloe	(07) 3870 4133	
Dr Geoffrey Fanning	(07) 5322 5904	Dr Charl Liebenberg	(07) 4153 9414	
Dr Lauren Galt	(07) 3832 7776	Dr Lee Rafter	(07) 4688 5480	
Dr David Deller	(07) 5539 4676	Dr Alex Ritchie	(07) 3832 7776	
Dr Iain Feather	(07) 5597 1622	Dr Tom Skinner	(07) 3832 7776	
Dr Maurice Heiner	(07) 3870 4511	Dr Chris Zappala	(07) 3371 0500	
RSHQ Approved Spirometry Provider