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Appointment Form
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Appointments
Appointment Form
request an
appointment online
Both doctors and patients can request appointments through this portal. It is important that you send us your referral. Without a valid referral, you may not get a medicare rebate.
For Patients
For Referring Doctor
For Patients
Name
*
First
Last
Date of Birth
*
Phone
*
Email
*
Primary Problem
*
Crohn's disease
Ulcerative colitis
Coeliac disease
Abdominal pain
Liver problems
Diarrhoea
Constipation
Incontinence
Anaemia
Unsure
Iron deficiency
Bloating
Abdominal pain
Other
Describe your condition
Preferred Day for Consultation
*
Monday
Tuesday
Wednesday
Thursday
Friday
First Available
Preferred Time for Consultation
*
Morning
Afternoon
Please note your preferred doctor may not have consulting times on your preferred day.
Preferred Doctor
Dr Crispin Corte
Dr Joseph Lawler
Dr Scott Davison
First Available
Do you have a referral?
*
Yes
No
Upload referral
If possible (as determined by the referral and your background health) would you prefer to go straight to gastroscopy/colonoscopy and avoid an appointment?
*
Yes
No
By clicking below, you agree that you have read and understood our
Privacy Policy
*
Yes, I've read and agree to your Privacy Policy
For Referring Doctor
GP Details
Name
*
First
Last
Practice
*
Provider ID
Phone
*
Email
*
Patient Details
Name
*
First
Last
Phone
*
Email
*
Patients' Primary Problem
*
Crohn's disease
Ulcerative colitis
Coeliac disease
Abdominal pain
Liver problems
Diarrhoea
Constipation
Incontinence
Anaemia
Unsure
Iron deficiency
Bloating
Abdominal pain
Other
Patient Date of Birth
*
Describe your patients condition
Additional Notes
*
Upload referral
select urgency
Referral / Level of Urgency
*
URGENT for attention of Gastroenterologist (for medical emergencies please instruct the patient to go to hospital, these emails are reviewed within 1-2 business days)
Referral for review and triage
Direct to Procedure
By clicking below, you agree that you have read and understood our
Privacy Policy
*
Yes, I've read and agree to your Privacy Policy
Phone
This field is for validation purposes and should be left unchanged.
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