Book a Telehealth Appointment

This form is for new appointments only. 

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.

To get started, what is your email address? *

Your appointment guide

Below is an overview of the steps involved in organising your telehealth appointment. For any questions or if you already have booked an appointment, please email bookings@phenixhealth.com.au.

Patient Type (Page 1 of 9)

Are you an existing or new patient? *

New patientExisting patient

Medicare (Page 2 of 9)

For eligible appointments our team will automatically claim your Medicare rebate for you. Any rebate will appear in your nominated bank account within 24-48 hours of your completed appointment. If you wish to change your nominated bank account please speak to Medicare directly.

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 will be sent directly to your preferred pharmacy. Our team will reach out to you to locate 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'.

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 - $55.00

Would you like to book with a Nurse Practitioner(NP) or General Practitioner(GP)? *

Nurse Practitioner(NP)General Practitioner(GP)*

*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.

 

MrMrsMissMsDr

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

StateQueenslandNew South WalesVictoriaWestern AustraliaNorthern TerritorySouth AustraliaTasmania

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.

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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