I was wondering if it had something to do with what they can charge @Glemmis. She just did not want to put it down as an indefinite referral. She ended up saying I can think about it and let her know next year. I think it may mean that she will have to charge me more and I will not get as much back from Medicare. The difference she quoted was about the same as a visit to the GP anyway so I thought for the convenience of not needing to go back to the GP it would be fine with me. But I will request a clearer explanation. Thanks for your input. :)