Step 1 Choose Your Doctor or Department Select the doctor or medical department you want to consult Step 2 Fill in Your DetailsEnter your name, phone number, email, and basic health information. Step 3 Select Date & TimeChoose a convenient date and time for your appointment. Step 4 Confirm Your AppointmentReview your details and submit the appointment request. Step 5 Visit the ClinicReceive confirmation and visit the clinic at your scheduled time. Patient Appointment Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Patient's First Name *Patient's Last Name *Phone NumberEmail Address *Patient's Medicare NumberYour 10 digit Medicare Card Number appears above the name(s) on your Medicare cardPatient's Medicare Reference NumberYour individual Medicare Reference Number is next to your name on your Medicare cardWhat service would you like to enquire about?Skin IssueHair problemTeeth problemHave you been diagnosed with ADHD? YesNo Number Number or Message or CommentSubmit