M&B Form 030 Appointment RequestURLThis field is for validation purposes and should be left unchanged.Use this form to let us know when you would like to book your next appointment. Indicate your preferences for days, time of day and when you would like your booking. Once we receive your request we will try and find a suitable time and send you a confirmation by email. Please note we are fully booked through January and February 2026. Name(Required) First Last Email(Required) Appointment Type Requested(Required) Regular Review Additional ReviewWhere(Required) In Person Telehealth No preferenceTimeframe(Required) a week a fortnight a month 2 months 3 months 6 Months 12 monthsIndicate your availability - select times when you can be available and unselect times when you cannot be available.Availability Tuesdays 9.30am to 10am 10am to 11am 11am to 12pm 1pm to 2pm 2pm to 3pmAvailability Thursdays 9.30am to 10am 10am to 11am 11am to 12pm 1pm to 2pm 2pm to 3pmAvailability Fridays 9.30am to 10am 10am to 11am 11am to 12pm 1pm to 2pm 2pm to 3pmAny additional informationAdditional Notes(Required)Please clarify urgency and if any medication issues.Terms and Conditions(Required)Requests for ADDITIONAL appointments may take 3 to 5 business days for us to respond. While we make best endeavors to accommodate requests there may be a waiting time of one month or longer before an appointment is available. For emergency care or in a life-threatening situation, call 000 or present to your nearest emergency department. Crisis support is also available through Lifeline on 13 11 14 or the Mental Health Emergency Response Line on 1300 555 788. Further useful information can be found at https://www.yourhealthinmind.org. Do not use this request form in a crisis. Responses may take up to 5 business days. By submitting this form you agree to these conditions. I agree with these conditions.