Request Appointment

Request Appointment Form

Request Form

Type of Enquiry

Your Details

Enquiry Information

Due to the high volume of calls and email enquiries received by our small, local in-house administrative team, you will usually receive a call back within two business days. We’re sorry we couldn’t catch your call the first time- we really do try! If you can’t wait for us to call you back, you’ll need to brave the hold music and call us on 4321 0500 during business hours. Please provide brief details of callback here (maximum 200 characters)*
This section is for general administrative enquiries only (all the fun paperwork questions!). We’re unable to provide medical advice via email, and this section is not for booking appointments. If you’d like to request an appointment, please select “Appointment” as the enquiry type from the drop-down menu. You’ll usually receive a response for general enquiries within three business days. Can’t wait? Skip the queue and call us on 4321 0500 during business hours. Please provide brief details of callback here (maximum 200 characters)*
0 of 200 max characters

Emergency Contact Details

You consent to this emergency contact also being listed as your next of kin, and you’re happy for us to contact them about your care if needed?

Referring Doctor

Is this your regular Doctor / GP?

Medicare, Private Health Insurance and DVA

Note: Concession cards are not accepted.

Do you have private health insurance which covers you for this service (e.g. gynaecology surgery or pregnancy care?).

Just a note: private health funds don’t cover consultations or in-rooms services. They only kick in when you’re admitted to hospital for gynaecology surgery, or birthing your baby. Most consultations and in-rooms services however do attract a Medicare rebate.

Do you have Veterans Affairs (DVA) card?

Upload Documents

Please upload the following documents. Some fields are mandatory, but to avoid delays in processing your referral, please upload all relevant documents you have, including all results and your referral letter.
 
Note: For behavioural paediatric appointments, we need some additional paperwork before we can book you in.
 
Please visit: https://intuitionprivate.com.au/paediatrics/ and see “Behavioural / Neurodivergent / ADHD / ASD – how to book an appointment” for details.

Maximum file size: 200MB

Allowed File Types: jpg, jpeg, jpe, png, gif, doc, docx, pdf.

Maximum file size: 200MB

Allowed File Types: jpg, jpeg, jpe, png, gif, doc, docx, pdf.

Other Information

0 of 200 max characters

Communication and Consent Information Preferences

We collect your personal and medical information so we can provide care, run the clinic, manage billing (including Medicare and Health Fund), and share relevant information with other health professionals involved in your care.

You don’t have to provide information, but if you don’t, it may affect the care we can provide. Most fields are mandatory on this form, so please call us on 4321 0500 if you need help.

Consent (Required)
If you do not consent to any of these please contact us via phone.

How did you hear about us?