UniSA Health Clinics – Appointment Booking Form

Please note that students are unable to see clients in relation to Medicare, Private Health and WorkCover Insurance claims.

If you are unable to complete this form please call the UniSA Health Clinics on 8302 0986. Messages can be left on the voicemail service if a receptionist is unavailable.

First Name

Last Name

Contact number

Contact email

Suburb

Date of Birth

Age

Are you booking for (Please select one)

Yourself

Your child

Please provide a brief description of your reason for booking an appointment

Which service did you want to book?

Which clinic location do you prefer?

Your privacy is important to us. Information you supply will be handled strictly in accordance with our Privacy Plan.

I have read and accept the conditions outlined in the Privacy Plan.

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UniSA Health Clinics – Appointment Booking Form

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UniSA Health Clinics – Appointment Booking Form

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