M&B Form 031 Appointment RequestX/TwitterThis 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 PreferenceThursday 30-July-2026Monday 03-August-2026Thursday 13-August-2026Friday 21-August-2026Monday 24-August-2026Tuesday 25-August-2026Tuesday 01-September-2026Thursday 03-September-2026Tuesday 08-September-2026Friday 11-September-2026Tuesday 20-October-2026Thursday 22-October-2026Tuesday 27-October-2026Thursday 29-October-2026Tuesday 17-November-2026Thursday 19-November-2026Tuesday 24-November-2026Thursday 26-November-2026Tuesday 22-December-2026Thursday 24-December-2026Tuesday 29-December-2026Thursday 31-December-2026Tuesday 05-January-2027Thursday 07-January-2027Tuesday 12-January-2027Thursday 14-January-2027Thursday 21-January-2027Thursday 28-January-2027Thursday 04-February-2027Thursday 11-February-2027Thursday 25-February-2027Tuesday 16-March-2027Thursday 18-March-2027Tuesday 23-March-2027Thursday 25-March-2027Thursday 08-April-2027Tuesday 13-April-2027Thursday 15-April-2027Thursday 22-April-2027Thursday 29-April-2027Tuesday 11-May-2027Tuesday 18-May-2027Tuesday 25-May-2027Thursday 27-May-2027Tuesday 01-June-2027Tuesday 08-June-2027Thursday 10-June-2027Tuesday 22-June-2027Thursday 24-June-2027Thursday 01-July-2027Thursday 08-July-2027Thursday 15-July-2027Tuesday 20-July-2027Thursday 22-July-2027Thursday 29-July-2027Second PreferenceMonday 03-August-2026Thursday 13-August-2026Friday 21-August-2026Monday 24-August-2026Tuesday 25-August-2026Tuesday 01-September-2026Thursday 03-September-2026Tuesday 08-September-2026Friday 11-September-2026Tuesday 20-October-2026Thursday 22-October-2026Tuesday 27-October-2026Thursday 29-October-2026Tuesday 17-November-2026Thursday 19-November-2026Tuesday 24-November-2026Thursday 26-November-2026Tuesday 22-December-2026Thursday 24-December-2026Tuesday 29-December-2026Thursday 31-December-2026Tuesday 05-January-2027Thursday 07-January-2027Tuesday 12-January-2027Thursday 14-January-2027Thursday 21-January-2027Thursday 28-January-2027Thursday 04-February-2027Thursday 11-February-2027Thursday 25-February-2027Tuesday 16-March-2027Thursday 18-March-2027Tuesday 23-March-2027Thursday 25-March-2027Thursday 08-April-2027Tuesday 13-April-2027Thursday 15-April-2027Thursday 22-April-2027Thursday 29-April-2027Tuesday 11-May-2027Tuesday 18-May-2027Tuesday 25-May-2027Thursday 27-May-2027Tuesday 01-June-2027Tuesday 08-June-2027Thursday 10-June-2027Tuesday 22-June-2027Thursday 24-June-2027Thursday 01-July-2027Thursday 08-July-2027Thursday 15-July-2027Tuesday 20-July-2027Thursday 22-July-2027Thursday 29-July-2027Third PreferenceThursday 13-August-2026Friday 21-August-2026Monday 24-August-2026Tuesday 25-August-2026Tuesday 01-September-2026Thursday 03-September-2026Tuesday 08-September-2026Friday 11-September-2026Tuesday 20-October-2026Thursday 22-October-2026Tuesday 27-October-2026Thursday 29-October-2026Tuesday 17-November-2026Thursday 19-November-2026Tuesday 24-November-2026Thursday 26-November-2026Tuesday 22-December-2026Thursday 24-December-2026Tuesday 29-December-2026Thursday 31-December-2026Tuesday 05-January-2027Thursday 07-January-2027Tuesday 12-January-2027Thursday 14-January-2027Thursday 21-January-2027Thursday 28-January-2027Thursday 04-February-2027Thursday 11-February-2027Thursday 25-February-2027Tuesday 16-March-2027Thursday 18-March-2027Tuesday 23-March-2027Thursday 25-March-2027Thursday 08-April-2027Tuesday 13-April-2027Thursday 15-April-2027Thursday 22-April-2027Thursday 29-April-2027Tuesday 11-May-2027Tuesday 18-May-2027Tuesday 25-May-2027Thursday 27-May-2027Tuesday 01-June-2027Tuesday 08-June-2027Thursday 10-June-2027Tuesday 22-June-2027Thursday 24-June-2027Thursday 01-July-2027Thursday 08-July-2027Thursday 15-July-2027Tuesday 20-July-2027Thursday 22-July-2027Thursday 29-July-2027Need 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: 512 MB, Max. files: 5.Any additional informationAdditional Notes(Required)Please clarify urgency and if any medication issues.Terms and Conditions including Cancellation Policy(Required)• This form is for existing patients only. • All follow-up appointments are conducted by telehealth. • Annual reviews are for patients on stimulant co-prescribing arrangements who have been advised that their annual review is due. • The clinic will determine the appropriate appointment type and duration based on your clinical needs and the reason for your request. • Submitting this form is an appointment request only and does not confirm an appointment. • We aim to respond within 3–5 business days. Appointment availability is subject to clinical priority and scheduling capacity. • 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. • 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.
