Book a Consult - 13 Doctor

Your name*
First Name Last Name
Date of Birth*
Gender*
- Male
- Female
Mobile Number*
Email Address*
Address*
Street Address City State Post Code
Medicare Number
Please note, your Medicare details are needed if you require a prescription or referral. Thank you.
Reference Number on Medicare Card
Expiry Date
Please show as MM/YYYY E.g. 06/2024
Do you hold a concession card
Please select yes if you hold a DVA or concession card.
Yes
Pharmacy Name
The doctor may prescribe you medication, please provide the name of the pharmacy that you would be able to collect this from.
Pharmacy Location
Please provide the suburb name or postcode where this pharmacy is located.
Where did you hear about us?
Access to video functionality
I DO NOT have access to a smart phone, tablet or computer with video functionality.
COVID-19 Question*
Have you tested positive for coronavirus – COVID-19? OR, Have you been in contact with a confirmed case of coronavirus? OR, Have you returned from overseas in the last 14 days? OR, are you isolating yourself at home on the advice of a medical practitioner?
- No
- Yes
Consent*
I agree to the Terms and Conditions.
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Consultation Fee*
Price: $ 49.00
Credit Card Payment*

Card Details

Cardholder Name