If you think you may have a medical emergency, please call triple zero (000) or go to the nearest hospital emergency department.

Please complete the form below to join our Telehealth cancellation list

This will be bulk billed if you are enrolled in the practice via MyMedicare. A standard GAP fee of $30 applies otherwise. Please note this does not guarantee you an appointment and may also be provided by any available Doctor if your preferred Doctor is not available.

If you have not had a face-to-face consultation with a GP at the clinic in the last 12 months, you will not be eligible for a Medicare rebate for a telehealth consultation.

Full Name *

Date of birth *

Mobile Number *

Preferred Date and Time

Preferred Doctor

If your need is related to a mental health concern, would you like our clinic’s Mental Health Nurse to contact you at no additional cost if your preferred Doctor is not available today? This will be followed by a quick consult by another GP as part of clinical safety protocol and this will all be bulk-billed. *

Yes No

If your need is related to a social support matter (e.g. MyAgedCare, Centrelink etc.), would you like our clinic’s Social Worker to contact you at no additional cost if your preferred Doctor is not available today? This will be followed by a quick consult by another GP as part of clinical safety protocol and this will all be bulk-billed. *

Yes No

I acknowledge that by joining our cancellation list I am not guaranteed to get an appointment. *

Yes No

I acknowledge the Doctor I requested may not be available, and my appointment may be provided by another Doctor who is available. *

Yes No

I agree for any consultation to be billed to Medicare if eligible, and to make any GAP payments where required. *

Yes No