medical referral form

I am a radiologist starting a diagnostic ultrasound imaging service called Beaches Ultrasound. The practice is located near the beach in Northern Beaches, Sydney Australia. Design referral form – please design in similar styles to the attached Vein Doctors Sydney referral form and Spectrum radiology referral form. I would like a typical A5 referral form (which will be used for referral pads) and an A4 computer referral form (similar to spectrum attachment). The A4 computer referral form assumes referring doctor computer software will supply patient details, examination required, clinical notes and referring doctor sections. I would also like a map for the back of the referral page (see below sample). It is located at the same location (same clinic) as Vein Doctors Sydney as it is affiliated with it. Could you please design a map that indicates where Beaches Ultrasound is located and that they should enter from Wentworth St. I have attached the logo of the business. Content attached Please provide pdf versions as well as editable versions.