TeleHealth Appointment Booking Request
Please complete the information below, click submit and we will be in touch to confirm your appointment date and time.
Please note:
We will be using PhysiApp OR Zoom to conduct the appointment. We will help guide you through the set-up prior to your appointment.
This form is to request an appointment. By clicking submit, it does not confirm that you have an appointment at the requested date and time. It is only confirmed when we get back in touch with you.
All TeleHealth appointments require payment in full prior to your appointment (you will be sent a link in the appointment confirmation email from us to make the payment)
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
-
Mobile Number
Date of Birth
*
-
Day
-
Month
Year
Date
Type of appointment
*
Initial consultation - new injury
Review/follow-up consultation
Home exercise program
Preferred Physio (please select more than one)
Emily
Katsu
Tamar
Adam
Bernie
Preferred appointment date
*
-
Day
-
Month
Year
Date
Preferred appointment time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Further notes
Submit
Should be Empty: