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Request an Appointment Form

Personal Information
Date of Birth *
More Information
Have you visited the clinic before? *
What Services are you interested in? *
Do you have any chronic illnesses? *
Do you have a concession card or full time university student card?
Acceptance
I understand the student clinics are unable to provide services for any third-party matters (including work related injuries and motor vehicle accident) *
I understand the student clinics are unable to provide rebates through private health funds and Medicare *