M&B Form 031 Appointment RequestLinkedInThis field is for validation purposes and should be left unchanged. This form is for existing patients requesting a follow-up telehealth appointment. Name(Required) First Last Email(Required) Appointment Type Requested(Required) Routine follow-up Annual review (for patients on stimulant co-prescribing arrangements) Earlier review due to a new concern Medication review or side effects Review and complete forms, reports or letters during my appointment OtherAll appointments are by Telehealth and are confirmed when we send you an appointment confirmation by email or SMS message. We will do our best to accommodate your preferences.First PreferenceTuesday 13-October-2026 MorningThursday 15-October-2026 MorningTuesday 27-October-2026 MorningThursday 29-October-2026 AfternoonThursday 26-November-2026 AfternoonTuesday 22-December-2026 AfternoonTuesday 19-January-2027 MorningThursday 21-January-2027 AfternoonTuesday 09-February-2027 AfternoonThursday 11-February-2027 AfternoonTuesday 09-March-2027 MorningThursday 11-March-2027 MorningTuesday 23-March-2027 AfternoonThursday 25-March-2027 MorningThursday 01-April-2027 MorningThursday 08-April-2027 MorningTuesday 13-April-2027 AfternoonThursday 15-April-2027 MorningThursday 22-April-2027 MorningThursday 29-April-2027 MorningTuesday 11-May-2027 MorningTuesday 18-May-2027 AfternoonTuesday 25-May-2027 MorningThursday 27-May-2027 MorningTuesday 01-June-2027 AfternoonTuesday 08-June-2027 MorningThursday 10-June-2027 MorningTuesday 22-June-2027 MorningThursday 24-June-2027 MorningThursday 01-July-2027 MorningThursday 08-July-2027 AfternoonTuesday 13-July-2027 MorningTuesday 20-July-2027 MorningThursday 22-July-2027 AfternoonTuesday 10-August-2027 AfternoonThursday 12-August-2027 MorningThursday 19-August-2027 AfternoonThursday 26-August-2027 MorningTuesday 07-September-2027 MorningThursday 09-September-2027 MorningTuesday 14-September-2027 MorningThursday 16-September-2027 MorningTuesday 21-September-2027 MorningThursday 23-September-2027 MorningTuesday 28-September-2027 MorningThursday 30-September-2027 MorningSecond PreferenceThursday 15-October-2026 MorningTuesday 27-October-2026 MorningThursday 29-October-2026 AfternoonThursday 26-November-2026 AfternoonTuesday 22-December-2026 AfternoonTuesday 19-January-2027 MorningThursday 21-January-2027 AfternoonTuesday 09-February-2027 AfternoonThursday 11-February-2027 AfternoonTuesday 09-March-2027 MorningThursday 11-March-2027 MorningTuesday 23-March-2027 AfternoonThursday 25-March-2027 MorningThursday 01-April-2027 MorningThursday 08-April-2027 MorningTuesday 13-April-2027 AfternoonThursday 15-April-2027 MorningThursday 22-April-2027 MorningThursday 29-April-2027 MorningTuesday 11-May-2027 MorningTuesday 18-May-2027 AfternoonTuesday 25-May-2027 MorningThursday 27-May-2027 MorningTuesday 01-June-2027 AfternoonTuesday 08-June-2027 MorningThursday 10-June-2027 MorningTuesday 22-June-2027 MorningThursday 24-June-2027 MorningThursday 01-July-2027 MorningThursday 08-July-2027 AfternoonTuesday 13-July-2027 MorningTuesday 20-July-2027 MorningThursday 22-July-2027 AfternoonTuesday 10-August-2027 AfternoonThursday 12-August-2027 MorningThursday 19-August-2027 AfternoonThursday 26-August-2027 MorningTuesday 07-September-2027 MorningThursday 09-September-2027 MorningTuesday 14-September-2027 MorningThursday 16-September-2027 MorningTuesday 21-September-2027 MorningThursday 23-September-2027 MorningTuesday 28-September-2027 MorningThursday 30-September-2027 MorningThird PreferenceTuesday 27-October-2026 MorningThursday 29-October-2026 AfternoonThursday 26-November-2026 AfternoonTuesday 22-December-2026 AfternoonTuesday 19-January-2027 MorningThursday 21-January-2027 AfternoonTuesday 09-February-2027 AfternoonThursday 11-February-2027 AfternoonTuesday 09-March-2027 MorningThursday 11-March-2027 MorningTuesday 23-March-2027 AfternoonThursday 25-March-2027 MorningThursday 01-April-2027 MorningThursday 08-April-2027 MorningTuesday 13-April-2027 AfternoonThursday 15-April-2027 MorningThursday 22-April-2027 MorningThursday 29-April-2027 MorningTuesday 11-May-2027 MorningTuesday 18-May-2027 AfternoonTuesday 25-May-2027 MorningThursday 27-May-2027 MorningTuesday 01-June-2027 AfternoonTuesday 08-June-2027 MorningThursday 10-June-2027 MorningTuesday 22-June-2027 MorningThursday 24-June-2027 MorningThursday 01-July-2027 MorningThursday 08-July-2027 AfternoonTuesday 13-July-2027 MorningTuesday 20-July-2027 MorningThursday 22-July-2027 AfternoonTuesday 10-August-2027 AfternoonThursday 12-August-2027 MorningThursday 19-August-2027 AfternoonThursday 26-August-2027 MorningTuesday 07-September-2027 MorningThursday 09-September-2027 MorningTuesday 14-September-2027 MorningThursday 16-September-2027 MorningTuesday 21-September-2027 MorningThursday 23-September-2027 MorningTuesday 28-September-2027 MorningThursday 30-September-2027 MorningNeed an earlier appointment? I am happy to accept an earlier appointment if one becomes available.Documents for Review (Optional) If your appointment relates to forms, reports or letters, you may upload them here for review before your appointment. Documents will not be completed without an appointment unless otherwise agreed with the clinic.File Drop files here or Select filesMax. file size: 50 MB, Max. files: 6.Any additional informationAdditional Notes(Required)Please clarify urgency and if any medication issues.Terms and Conditions including Cancellation Policy(Required)โข This form is for existing patients only. โข All follow-up appointments are conducted by telehealth. โข Annual reviews are for patients on stimulant co-prescribing arrangements who have been advised that their annual review is due. โข The clinic will determine the appropriate appointment type and duration based on your clinical needs and the reason for your request. โข Submitting this form is an appointment request only and does not confirm an appointment. โข We aim to respond within 3โ5 business days. Appointment availability is subject to clinical priority and scheduling capacity. โข A minimum of 48 hours' notice is required to cancel or reschedule an appointment. Appointments cancelled or rescheduled with less than 48 hours' notice, or appointments not attended, may incur a cancellation fee in accordance with the clinic's Cancellation Policy. โข This form must not be used for urgent or emergency mental health concerns. If you require immediate assistance, call 000 or attend your nearest Emergency Department. Crisis support is available through Lifeline (13 11 14) or the Mental Health Emergency Response Line (1300 555 788). I agree with these conditions.