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For emergency please call 000

For all emergencys, please call 000. If your matter is not an emergency please scroll down to use our booking form. Any questions please do not hesitate to contact us.

(07) 4169 0050

Booking form for new patients

Using this form does not secure your booking with a doctor. Someone from our clinical staff will call you to confirm your appointment.

First Name

Last Name

Address

Suburb

Postcode

Phone Number

E-Mail

Date of Birth

Sex

Are you aboriginal or torres strait islander

Medicare Number

Medicare Expiry

Medicare ID number

Emergency Contact First name

Emergency Contact last name

Emergency Contact Relationship

Emergency Contact Number

Family Doctor Practice

Family Doctor Name

Family Doctor Address

Family Doctor Number

Complaint

Allergy

Medical History

Medications

Acknowlagement

By ticking this box, you consent to relevant information including images regarding your treatment being provided to other health professionals involved in your care (E.G. GP, referring doctor etc)

I understand I will be contacted within the next 6 hours by one of our staff members to confirm. This booking form does not gaurentee a booking with a doctor and you will be assess accordingly.

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For emergency please call 000

(07) 4169 0050

Booking form for new patients

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