Specialist Outpatient Clinic Enquiries

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*

Please enter a valid date in the format (dd/mm/yyyy).

Address*

Medicare Number*

Enter Medicare Number or "Medicare Ineligible"

Nature of Enquiry*

Choose from this drop down menu.

Nature of Enquiry*

Choose from this drop down menu.

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*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

G.P. Details - Name

Clinic

Address

Phone Number

Other

Reschedule / Cancel 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

When is your appointment?*

Please enter a valid date in the 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.

Reason for rescheduling/cancelling*

Any other comments?

How would you like us to answer your enquiry?*

Phone*

Email*

Do you have my referral?

Referrer Information

General Practitioner name

Clinic

Address

Phone Number

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

Any other comments?

How would you like us to answer your enquiry?*

Phone Number*

Email*

General Enquiries

Speciality (if applicable)

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?*

Contact Name*

Profession*

Email*

Contact Name*

Profession*

Phone*

Respond to Waiting List Audit

For which Specialty Clinic are you currently waiting for an appointment?*

Do you want to remain on the Waiting List?*

Yes
No

If yes, you will remain on the waiting list and be offered an appointment as soon as possible. If your situation changes and you no longer require an appointment, please let us know via Contact Us. If your condition changes, please see your GP for an updated referral. If not, your referral will be closed. You will require a new referral from your GP to be receive an appointment.

Any other comments?

How would you like us to answer your enquiry?*

Phone*

Email*

Patient Related Enquiry

Patients NH UR Number (if known)

Patients Full Name*

Date of Birth*

Please enter a valid 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*

Contact Name*

Profession/Clinic*

Phone Number*

Contact Name*

Profession/Clinic*

Email Address*

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

Respond to Waiting List Audit

Patient Related Enquiry

Your feedback is important to us

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