Before you request for an appointment

A valid doctors referral

A referral from a general practitioner(GP) is required. Please let your GP knows if you have a specific specialist you would want to get an appointment with.

Note: A referral from a GP will valid for 12 months. A new referral should be obtained from your local doctor every 12 months or for each new problem.

Request for an appointment

Once you have got your referral, please fill in the request for an appointment form below and attached a copy of your scanned referral.

Alternatively, you can call us at 03 9345 6888 or get your GP to submit the referral via our website, fax or email.

Confirmation

Once the request has been received, we will get in touch with you as soon as possible to organise the appointment.

Appointment Request Form

01. Choose Type/Specialty

*Please select a few in case the first specialist is not available

Choose Type/Specialty*
02. Please Select
Please Select
- New Patient
- Return Patient
03. Patient Information:
First Name*
Last Name (Surname)*
Date of Birth*
Email*
Mobile Number*
Home Number*
04. Parent/ Guardian Details

*If applicable
Gaurdian
First Name*
Last Name (Surname)*
Relationship*
Date of Birth*
Email*
Mobile*
05. Referral
Please upload a scanned copy of your referral*
Drop files here or

Max. file size: 50 MB.
Comments
This field is for validation purposes and should be left unchanged.

Before you request for an appointment

A valid doctors referral

Request for an appointment

Confirmation

Appointment Request Form

Gaurdian