headspace Ballarat Sexual Health Clinic

Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Age
Phone Number*
mobile preferred - we are unable to hold bookings without a valid phone number
Medicare Number
Enter your 10-digit Medicare number
Medicare expiry date
MM/YY
Address

Street Address

Street Address Line 2

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Postcode
Appointment Times - select your preferred date and time*
headspace Ballarat Sexual Health Clinic

Book a Sexual Health appointment at headspace Ballarat by clicking this link:

https://ballarat-ch.hothealth.com/appointments

or

call 53044777 between 9am-5pm weekdays.
Should be Empty: