Book Appointment

Appointment requirements
For general appointments, we require a valid referral letter (from a GP or specialist).
We also require a Patient Detail Form which can be completed below.

Call or Email us to book in (or if you have any questions)
Phone  (08) 81511333
Fax   (08) 81511334
Email   [email protected]

Telehealth / Phone appointment
It is possible to schedule some appointments via telehealth, in particular for patients living in remote or regional areas (this incurs a fee similar to a face to face appointment).

Patient Detail Form

* Indicates required field

First name *

Last name *

Phone number *

Email Address *

Occupation *

Date of Birth *

Height (cm) *

Weight (kg) *

Gender *

Pronouns *

Address (Residential and Postal) - Please write in both if they are different *

Insurance Status *

Privately Insured Self Funding Overseas Cover

Health Fund Name *

Fund Membership Number *

Year of Joining *

Expiry Date *

Medicare Number (or Veteran's Affair no.) *

Name of GP Practice *

Name of GP (or Referring Doctor if not GP) *

Next of Kin / Emergency Contact Person *

Relationship to You *

Phone Number *

Can we share information with next of kin? *

Yes No, please do not share info with next of kin

Medications List *

Any Allergies? *

I consent to receiving SMS / Email correspondence related to my appointment *

Yes

I have read + understood the privacy policy below *

Yes

Submit