Appointment Request Form

This form will assist you in submitting your request for an appointment with Dr Kate Law.

First Name *

Last Name *

Email Address *

Date of Birth *

Fee Information

Consultation Fees

Fee Information

Please refer to our practice information manual for current fees

Pre-payment required

You will be required to pay your estimated consultation fee at least 48hrs before your appointment. More details are available in the practice information manual

Deposit required

If you have previously cancelled your appointment at short notice, or you have missed an appointment, you will be required to pay a deposit to secure an appointment booking. More details are available in the practice information manual

Extra time charges

If your appointment goes over the booked time, you will be charged for the additional time as per our fee policy.

Click to Open Practice Information Manual

I confirm I am aware of the current fees and fee policies and agree to the payment terms *

Appointment Preferences

This section will ask you to indicate your appointment preferences to allow admin to assist you as quickly as possible.

When would you prefer to be seen by Dr Law? * Note: If we do not have appointments available within your preferred time-frame, we will book the next available appointment thereafter.

Please provide further details below *

Which day would you prefer? *

Tuesday morningThursday morningI have no preference

Would you prefer a phone call or a video call? *

Phone callVideo call

What is your preferred appointment length? *

Standard consultation (up to 20min)Long consultation (30-40min)

If we don't have long consultations available around your preferred date, would you like us to book a standard consultation (up to 20min) instead? *

Yes. I am aware this shorter appointment must finish on time, even if we haven't addressed everything on my listNo, I would prefer to wait for the next available long consultation

Is the main purpose of your appointment to renew your prescription(s)? *

Yes - I don't want to make any changes to my medicationsYes - I want to make changes to my medicationsNo - I have other matters to discuss

You may be eligible for a prescription request as a temporary measure to reduce appointment wait times. If you are eligible, would you prefer to submit a prescription request instead? *

Yes, I would prefer to submit a prescription request (if I am eligible)No, I would prefer to book an appointment

Waitlist Preferences

Waitlist Information

If you would like to be added to the waitlist, please indicate this below. The following terms will need to be agreed to in order to access the waitlist:

You agree to be contacted with an appointment offer
If an appointment is offered at short notice due to a cancellation, you will receive an SMS. If we do not hear from you by the deadline provided, the next person on the waitlist will be offered the appointment.
You will be required to pre-pay your estimated consultation fee to secure the booking, as per our fee policy

Would you like to be added to the waitlist? *

YesNo

Great! We will add you to the waitlist as requested. Please indicate your preferences and confirm your agreement to the waitlist terms above.

How much notice do you require to be available for an appointment if an offer comes up? *

I can be available at very short notice (same day)At least one days' noticeAt least 2 to 3 days' noticeAt least 4 to 5 days' noticeAt least 6 to 7 days' noticeI need 8 days' notice or more

I agree to the waitlist terms outlined above *

Appointment Frequency

Following this appointment, what would be your preferred frequency of appointments? *The frequency will be taken into account when scheduling appointments, however if clinical need identifies more frequent appointments are required, Dr Kate will advise.

Submit Appointment Request

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Full Name *

Today's Date *

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