Coastal Medical Imaging: Online Appointment Request

Appointment Request

REQUEST AN APPOINTMENT

At our patient-cantered practice, we’re committed to making the booking process quick and easy for you.

We know scheduling an appointment can sometimes be challenging but rest assured – we’ll do our best to ensure you get the test you need. Below, you’ll find helpful tips and answers to common questions to keep things running smoothly.

Please note: Submitting this form does not guarantee an appointment time. Our Booking Team will contact you to confirm the details and finalise your booking. For immediate assistance, feel free to call us directly.

Our Booking Team will reach out to discuss your request and confirm an appointment time. If you’d prefer to speak with someone immediately, please don’t hesitate to give us a call on (02) 8319 4863.

First Name

Last Name

Date of Birth (DD/MM/YYYY)

Gender

Is your appointment related to a workplace injury?

Yes No

Service

Date - first preference (DD/MM/YYYY)

Time - first preference

Date - second preference (DD/MM/YYYY)

Time - second preference

Phone number

Email address

Copy of referral #1 (Scan or take a photo of your referral and upload it here)

Copy of referral #2 (Scan or take a photo of your referral and upload it here)

Other information

By submitting this form, I acknowledge that if I experience flu-like symptoms on the day of my appointment, I will need to reschedule.