COVID-19 Travel Certification Form

Appointment Request
Skin Cancer Clinic Appointment Request:
Please provide preferred date (Monday-Friday) and time (9am-1pm) for your appointment below. We will contact you to confirm this appointment request.

Please bring a photo ID and medicare card (if you have one) to the appointment.

Standard consultation fees are $90 and you will receive a medicare rebate, which will be processed on the day.
Are you a new patient to our Clinic?*

YesNo
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Urgency of appointment

Within 1 weekWithin 2 weeksNext available
Should be Empty: