Book Online V4

City Clinic
Secured Booking Form
Please complete all questions.

Health Pass:

Are you an existing patient of City Clinic?

Full Name

First NameLast Name

Your E-mail Address

If your details have not changed, since your last appointment, we only need your mobile number to process your appointment request - Have they changed?

After you make your appointment we will take you to our patient data change form so you can update your patient file. This will only take a minute.

To make this appointment we still only need your mobile number unless that has also changed.

Mobile Changed?

Your Mobile Number

As your mobile has changed we will need your name to locate your patient file, your new mobile and your preferred e-mail address.

First NameLast Name

Your New Mobile

Please provide your preferred email address

Please select your usual health service

Please choose the service for this appointment

If not listed please indicate the service

Were you referred by a healthcare professional?

Name and suburb of referrer

Preferred day for your appointment - Closed Public Holidays

Your preferred time period for your appointment

When should we contact you to confirm your appointment?

Please provide details about your injury or other requirements

Notes