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Let's start with you

Your name and email so we can hold your spot and send you a reminder.

Your name

First name*

Last name*

Contact details

We'll use this to confirm your appointment and send you a reminder — we never share your details with third parties.

Email address*

Date of birth*

Location

Postcode

State / Territory

Medicare details

Required so your doctor can write prescriptions and apply Medicare rebates to your consultations.

Medicare card number

Individual reference number (IRN)

Card expiry

Your Medicare details are stored securely and used only for prescription and rebate purposes. You can provide these later if you don't have your card handy.

Biological sex

This helps us tailor medical questions appropriately.

Pronouns