Thanks for submitting the form.

To be eligible for a doctor appointment, we require you to complete a medical questionnaire relating to some recent medical history and provide any supporting documents (MyHealth summary, GP/Specialist referrals or evidence of previously prescribed medication)

This form typically takes under 5min to complete, depending on your medical history.

If you have time to complete this now, please click the button below, alternatively we will email this form to you to complete later.

Once completed you can book a telehealth consult with one of our patient support team to assess your condition, history and discuss the process.

Mediflora team