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Appointment Request

SCHEDULE AN APPOINTMENT

This form is a request for an appointment and does not guarantee a reserved time. A team member will follow up with you to confirm your appointment. If you’d rather speak with someone, please give us a call.

First Name

Last Name

Date of Birth (DD/MM/YYYY)

Gender

Service

Practice

Date (DD/MM/YYYY)

Time

Phone number

Email address

Is your appointment related to a workplace injury?

Yes No

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 request, I acknowledge that should I have flu-like symptoms on the day of my appointment I will need to reschedule.

My Health Record Notice: From 1 July 2026, pathology and diagnostic imaging providers are generally required to upload results to My Health Record by default. Please note: Our practice has been granted an extension to implement this requirement. During this time, your diagnostic imaging reports and results will not be uploaded to My Health Record. If you have any questions, please speak with a member of our team.

Appointment Request

SCHEDULE AN APPOINTMENT

Bayside Radiology

Beachside Radiology

Bolsover Radiology

Bundaberg Radiology