Colonoscopy

Appointment Request

Please note: items marked * indicate mandatory fields.

Complete this online form to book a “No-Gap” colonoscopy in the public hospital (if you have a Medicare card), or in a private hospital (if you have private health insurance or DVA).

Personal Detail

Please enter date using the format DD/MM/YYYY

Contact Details

Please enter phone number with area code included. No spaces please. eg. 0298765432

Please enter phone number with area code included. No spaces please. eg. 0298765432

Please enter your full mobile number. No spaces please. eg. 0412345678

Memberships

10 Digits

1 digit next to cardholder's name

Please enter "Valid To" date - using the format MM/YYYY

Are you a member of the Department of Veterans Affairs (DVA)?
Do you require DVA transport booked for you?
Emergency Contact

Please enter phone number with area code included. No spaces please. eg. 0298765432

Please enter phone number with area code included. No spaces please. eg. 0298765432

Medical information

Please enter phone number with area code included. No spaces please. eg. 0298765432

Are you otherwise healthy with no recent hospital admission with breathing or heart conditions, and are not taking blood thinner

Are you otherwise healthy with no recent hospital admission with breathing or heart conditions, and are not taking blood thinners (e.g., warfarin, clexane or dabigatran)?

Appointment Details

Please enter date using the format DD/MM/YYYY

Applicable Hospital Type
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