COVID-19 Travel Certification Form

General Practice Appointment Request:
Please provide the urgency of your appointment below. We will contact you to confirm this appointment request (Monday-Friday 8:30am-1:30pm)

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

Standard consultation fees are $95 and you will receive a medicare rebate, which will be processed on the day

Are you a new patient to the practice?*

YesNo

Type of appointment?*

Standard ConsultationLong ConsultationMental Health ConsultationPhone Consultation

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Urgency of appointment*