Doctor Appointment Request Form

Doctor Appointment Request Form

就诊需求表
Name 姓名*

First NameLast Name
Email 邮箱*
example@example.com
Phone Number 手机号*
Please select a service 请选择您需要的服务类型*

General Medical Consult 医疗咨询 (根据临床指征，医生将开具相应检查、处方或假条等) - AUD$39Medical Certificates 假条 - Single Day 单日 AUD$20.8 / Multiple Days 多日 AUD$39Prescriptions 长期慢性药物处方 - Single Medication 单种药物 AUD$29 / Multiple Medications 多种药物 AUD$39 (*如需抗生素，请选择医疗咨询。If require antibiotics, please select General Medical Consultation.)Pathology Referrals 查血/化验单 - From AUD$15.8Specialist Referrals 专科医生推荐信 - AUD$39

Appointment