Telehealth Consultations

Consultation Purpose

Important: This form is used to help our practitioners understand your concerns ahead of your telehealth consultation. It is not a substitute for emergency care. If this is an emergency, please call 000 or attend your nearest hospital.

What is the main reason for your consultation? *

Is this a new issue or a follow-up? *

New issue Follow-up

How long have you been experiencing this issue?

Have you previously discussed this issue with a healthcare provider?

Yes No

Medical Background

Please tell us a bit about your general health background. This helps the clinician better understand your needs and ensure safe recommendations during the consultation.

Do you have any chronic medical conditions? *

Heart disease Diabetes Asthma Mental health conditions None of the above

Please list any regular medications you are currently taking:

Do you have any allergies to medications? *

Yes No

If yes, please specify the medications you're allergic to:

Telehealth Readiness

Telehealth Policy: By continuing, you confirm that you understand this is a remote consultation conducted via phone or video call. It may have limitations compared to in-person visits. In some cases, a follow-up or in-person appointment may be required after this consultation.

Do you have a stable internet connection or phone service for this consultation? *

Yes No

Are you comfortable receiving prescriptions, referrals, or certificates digitally? *

Yes No

What is your preferred method for this consultation? *

Phone Video call No preference

Please tell us briefly what brings you to see the doctor today. *

Consent & Signature

Consent: I understand that this is a telehealth consultation and that the doctor will rely on the information I provide. I acknowledge that a physical examination may not be possible and that further follow-up may be required based on clinical judgment.

I agree to proceed with this telehealth consultation. *

I confirm that I understand the limitations of telehealth and agree to proceed.

Signature *

Confirm Your Details

We’ll use your email to match your booking. Please enter your Medicare number to confirm.

Email *

Medicare Number *

Medicare Reference *

Important: use the same email

We match your booking detais to this form using your email address. Please make sure the email below is exactly the same in the next form.

If the email doesn’t match, we may not be able to find your questionnaire automatically, which can delay your request.

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Telehealth Consultations

Book Your Telehealth Consultation

Consultation Purpose

What is the main reason for your consultation? *

Is this a new issue or a follow-up? *

How long have you been experiencing this issue?

Have you previously discussed this issue with a healthcare provider?

Medical Background

Do you have any chronic medical conditions? *

Please list any regular medications you are currently taking:

Do you have any allergies to medications? *

If yes, please specify the medications you're allergic to:

Telehealth Readiness

Do you have a stable internet connection or phone service for this consultation? *

Are you comfortable receiving prescriptions, referrals, or certificates digitally? *

What is your preferred method for this consultation? *

Please tell us briefly what brings you to see the doctor today. *

Consent & Signature

I agree to proceed with this telehealth consultation. *

Signature *

Confirm Your Details