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Before you request for an appointment

01

A valid doctors referral

A referral from a general practitioner(GP) is required. Please let your GP know if you have a specific specialist you would want to get an appointment with.

Note: A referral from a GP will valid for 12 months. A new referral should be obtained from your local doctor every 12 months or for each new problem.

02

Request for an appointment

Once you have got your referral, please fill in the request for an appointment form below and attached a copy of your scanned referral.

03

Confirmation

Once we have processed your referral, we will contact you to arrange an appointment time.

Please note, if you are a new patient, we will be unable to arrange an appointment until we have received your referral.

Appointment Request Form

01. Choose Type/Specialty

*Please select a few in case the first specialist is not available

Choose Type/Specialty*
02. Please Select
Please Select
- New Patient
- Return Patient
03. Patient Information:
First Name*
Last Name (Surname)*
Date of Birth*
Email*
Mobile Number*
Home Number*
04. Parent/ Guardian Details

*If applicable
Gaurdian
First Name*
Last Name (Surname)*
Relationship*
Date of Birth*
Email*
Mobile*
05. Referral
Please upload a scanned copy of your referral*
Drop files here or

Max. file size: 50 MB.
Email
This field is for validation purposes and should be left unchanged.