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Lung Function Laboratory Referral Form

We are a Southern Cross Affiliated Provider


Sleep & Breathing (NZ) Limited
Ascot Office Park, Level 3, Building B
93-95 Ascot Avenue, Greenlane East
P O Box 109-409, Newmarket
Auckland 1149
Fax: 09 638 6022
Telephone: 09 638 5255
Email: referrals@nzrsi.health.nz
PATIENT'S DETAILS
  • Example: 29/03/1969
  • Example: (649)845-0088
  • Example: (649)845-0088
  • Example: (64)21-456789
TEST REQUESTED (Patients should withhold inhalers on the day of the test)
  • Spirometry with Flow/Volume loops
    Pre and post bronchodilator
    Lung volumes and flows with DLCO
    Pre and post bronchodilator
    Exercise VO2 assessment
    6 minute walk test
    Static mouth pressures (for muscle weakness)
    Challenge testing
    Tidal breathing (for Hyperventilation Syndrome)
    Arterial blood gas (Home O2 assessment)
    Hypoxic challenge for flying
    Induced sputum
    FENO
Referring Doctor
  • Example: (649)845-0088
  • Example: 23/01/2010

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