Specialist Outpatient Clinic Enquiries

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Home/
Specialist Outpatient Clinic Enquiries

Specialist Outpatient Clinic Enquiries

Home/
Specialist Outpatient Clinic Enquiries

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– Step 1 of 3

Are you a Patient or GP/Health Professional?

UR Number

Updates to patient information can only be made if the UR is supplied and it matches our records.

Email Address *

Enter N/A if you do not have an email address.

Name *

First

Last

Please write your name here.

Date of Birth *

Date in the format (dd/mm/yyyy).

Address* *

Medicare Number *

Enter Medicare Number or “Medicare Ineligible”

Nature of Enquiry *

Any other comments? *

Please fill in any additional comments you may have.

How would you like us to answer your enquiry? *

When is my appointment?

Which Specialty Clinic are you expecting an appointment at? *

If your enquiry is related to Allied Health or Cardiology, please contact the department on the below details: Allied Health Telephone: 8405 8580. Email: NH-AlliedHealthOutpatients@nh.org.au Cardiology Ph: 8405 8554 Email: cardiologyoutpatients@nh.org.au

Patient Details

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

answer Date enquiry?

G.P. Details – Name

Clinic

Address

Phone Number

Other

Reschedule / Cancel Appointment

Which Specialty Clinic are you expecting an appointment at? *

When is your appointment? *

Date format (mm/dd/yyyy)

Do you want to cancel or reschedule? *

Please note if you are cancelling, your referral will be closed and you will need to see your GP for another referral if you need a future appointment. If you are rescheduling, a member of staff will review your appointment and respond whether if it is possible or safe.

Please specify when you would like to reschedule this appoitment?

1-2 weeks
3-4 weeks
5-6 weeks

Please be aware that many clinics have high demand. You may return to the waitlist where a future appointment will be offered. We will do our best to accommodate your request, but you will be scheduled for the earliest available appointment.

Reason for rescheduling/cancelling *

Any other comments?

How would you like us to answer your enquiry? *

Do you have my referral?

Referrer Information

General Practitioner name

Clinic

Address

Phone Number

Which Specialty Clinic are you expecting an appointment at? *

Any other comments?

How would you like us to answer your enquiry? *

General Enquiries

Please enter your enquiry *

Please enter as much information so we can accurately respond to your enquiry.

How would you like us to answer your enquiry? *

Patient Related Enquiry

Patients NH UR Number (if known)

Patients Full Name *

First

Last

Date of Birth *

Date in the format (dd/mm/yyyy)

Address *

Contact Number *

Please enter your enquiry *

Please enter as much information so we can accurately respond to your enquiry.

How would you like us to answer your enquiry *

Please note: We do not accept GP Referrals via Email

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Specialist Outpatient Clinic Enquiries

When is my appointment?

Patient Details

Reschedule / Cancel Appointment

Do you have my referral?

General Enquiries

Patient Related Enquiry

Latest News

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North Metro and Mitchell Local Health Service Network launch

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