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New consultation

Consultation

Patient:

For patient’s safety, we need to ask patient some questions. At any stage if patient feel very unwell or patient’s symptoms get worse, patient must seek immediate medical attentio..

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Patient confirm he is in Australia and his personal details are up to date.

Yes No

Patient confirm that he is not seriously unwell, he just need consultation.

Yes No

Do patient have any of the following symptoms currently:

Pain in Chest
Slurred speech
Shortness of breath
Weakness or numbness down one side
Unable to swallow fluids or saliva

Yes No

Patient need a consultation for one of the following conditions:

What date do you need the consultation?

Please select the best time slot for a consultation [AEST]:

Prefered Mode of Consultation:

Your Whatsapp Mobile #

Your Skype ID

Your Viber Mobile #

Your Facetime Mobile #

Your Google Duo Mobile #

Your Mobile #

Your Landline #

Patient have read and accept the terms & conditions and privacy policy.

Yes

We are sorry we are unable to help, please see a doctor.

We are sorry we are unable to help, please see a doctor.

Patient's answer indicates that he needs urgent medical attention. Please call 000.

Select Date & Time

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New Family Member

Relationship With Account Holder *

First Name *

Last Name *

Gender *

Date of Birth *

Mobile *

Any Disability *

Address *

Suburb *

Select Patient

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