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Book a Telehealth Appointment

This form is for new appointments only. All consultations are $59 Anytime

For help with existing appointments, please email our team at bookings@phenixhealth.com.au.

Welcome

Welcome to Phenix Health, this booking form will be used to create your patient account and organise an appointment with one of our Healthcare Practitioners. All information provided is kept private and confidential.

For any questions or if you already have booked an appointment, please email bookings@phenixhealth.com.au .

To get started, what is your email address? *

Patient Type (Page 1 of 9)

Are you an existing or new patient? *

New patientExisting patient

Medicare (Page 2 of 9)

A valid Medicare card is required to validate and verify your details in order to receive an e-script. No GP appointments with a Telehealth Doctor as rebateable due to Government rule that patients must have been seen by the Doctor face to face to be eligible for a Telehealth consultation with that Doctor.

Do you have a Medicare card? *

YesNo

You must have a Medicare, DVA card or IHI# in order to receive an escript to your phone. Private Billed patients are able to have their prescription sent to their nominated pharmacy.

If you do not have a Medicare, DVA card or IHI# your prescription can be sent directly to your preferred pharmacy. Please nominate your preferred or closest pharmacy.

Do you use a different name in your Medicare card?

YesNo

Your name must match what is on your Medicare Card.

Medicare first name

Medicare surname

Medicare card no. *

Medicare reference no. *The reference number is the number next to your name on your Medicare card.

Medicare expiry *

You have selected you are an existing patient. If your Medicare details have changed, please go back and select 'New patient'.

Booking Request Type (Page 3 of 9)

S8 Medication: It is not possible for our Healthcare Practitioners to provide any S8 medications, please do not proceed to book a consultation if you are seeking such medication as your consultation fee with the Healthcare Practitioners will not be refunded.

I am after: *

Short Telehealth Consultation - $59.00

*Medicare rebates only available for consultations with NPs. GPs private billing only. By continuing I understand and accept this. *

How would you prefer to have your telehealth consultation? *

Video call Phone call

When would you prefer to have your telehealth consultation?

ASAPChoose a time/date

Preferred time and date

Reason for consult:

Patient Details (Page 4 of 9)

The information and details entered here may also appear on your prescription and other relevant medical documents. It is important to provide accurate and correct information to avoid any potential issues after your appointment.

First name *

Last name *

Preferred name

Date of birth *

Gender

MaleFemaleTransgenderNon-binary

Patient Contact Details (Page 5 of 9)

Our team will use the following information to contact you. Please review your information, as any incorrect data may lead to a delay in receiving your telehealth appointment.

Mobile phone *

Address *

Postcode *

City / Suburb

State

Health History (Page 6 of 9)

By completing this section it enables our Healthcare Practitioner to better assess you during your telehealth appointment.

If you are currently taking medication, please list here:

Do you smoke?

YesNo

Do you have a history of blood pressure?

YesNo

Do you have any allergies?

YesNo

Please list your allergies:

Have you had a heart attack, stroke or other cardiovascular concerns recently?

YesNo

Do you have any of the following medical conditions?

Lung diseaseHeart diseaseMental healthNo

Are you pregnant, or likely to become pregnant? *

YesNo

If so, are you breastfeeding?

YesNo

Consent (Page 7 of 9)

By submitting this form I agree to the Terms and Conditions, Privacy Policy and Billing Policy. Including that your Healthcare Practitioners will collect such information (including any personal or sensitive information), for the purposes of providing health services or enabling any related communications.

PRIVACY COLLECTION NOTICE

This Privacy Collection Notice describes how PHENIX HEALTH PTY LTD (ABN 22 607 822 266) (we, us or our) collects and handles your personal information when you receive health services from us. We collect personal information from you and from third parties (such as your healthcare providers) so that we can provide health services to you and for related purposes set out in our Privacy Policy, available on our website (or on request).

We may disclose this personal information to third parties, including our personnel, related entities, your healthcare providers, any third parties engaged by us and acting on our behalf and as otherwise set out in our Privacy Policy (including our pharmacy partners and any necessary regulatory bodies).

We store personal information in Australia. Where we disclose your personal information to third parties, those third parties may store, transfer or access personal information outside of Australia.

If you do not provide your personal information to us, it may affect our ability to do business with you.

Please see our Privacy Policy for more information about how we collect, store, use and disclose your personal information, including details about overseas disclosure, access, correction, how you can make a privacy-related complaint and our complaint-handling process.

If you have questions about our privacy practices, please contact us by email at: bookings@phenixhealth.com.au. By providing your personal information to us, you agree to the collection, use, storage and disclosure of that information as described in this privacy collection notice.

Payment (Page 8 of 9)

Please complete the following payment prior to submitting your form *

Review and Confirmation (Page 9 of 9)

I confirm that the above information I have provided is true, complete and accurate. *

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