New Patient Inquiry

New Patient Inquiry

Appointment information or booking request
Name of patient*

First NameLast Name
Birth Date

MonthDayYear
Name of parent or guardian if you are arranging on another's behalf

First NameLast Name
Phone number*
Email*
example@example.com
What health concerns do you wish to address?
How can we best help you?

Arrange an appointment with a doctorArrange an appointment with our dietitian, Jillian DimockArrange an appointment with our psychologist, Sabrina YangProvide information about fees or waiting timesDiscuss best doctor to see for my conditionUnderstand what procedures and testing we perform
Do you have a referral from your GP or other specialist?

YesNo
Has your referral been sent to our clinic?

YesNo
Please upload your referral if we have not already received this

Browse Files

Cancelof
Do you have a preference for a doctor you wish to see?

YesNo, just next available
Doctor(s) that you would prefer to see

Dr Marius BothaDr Katharine FosterDr Kathryn HeyworthDr David Heyworth-SmithDr Carl KennedyDr Ji Hye LimDr Andrew MerryDr Susan PerelDr Babu PhilipDr Kim RobertsonDr Zi TanDr Venetia WhiteheadDr Sophie Willcocks
Clinic locations you would prefer to attend (** Your doctor may not attend your preferred site **)

GreenslopesGrangeBirtinya (Sunshine Coast)ToowoombaTelehealth
Day of the week you would prefer an appointment (** Doctors vary in their schedule availability **)

MondayTuesdayWednesdayThursdayFriday
Best days and times for us to contact you
Any other comments or requests
Should be Empty: