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⚠️ Medical Emergency

If you are experiencing a medical emergency, do not use this booking form.

Call 000 immediately or go to your nearest emergency department.

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Schedule Your Appointment

We'll contact you within 24 hours to confirm your appointment details. For urgent appointments, please call our practice directly.

✓ Appointment Request Submitted!

Thank you for your appointment request. We will contact you within 24 hours to confirm your booking details.

📋 Before You Book

Please ensure you have your Medicare card and any referral letters ready. We'll contact you to confirm your appointment and provide any specific preparation instructions.

Patient Information

First Name *

Last Name *

Phone Number *

Email Address *

Date of Birth

Medicare Number

Appointment Details

Type of Appointment *

Preferred Date

Preferred Time

Urgency Level

Medical Information

Referring Doctor

Attach Referral (optional) Allowed file types: PDF, DOC, DOCX, JPG, JPEG, PNG

Current Symptoms or Concerns

Current Medications

Additional Information

Need Help?

Phone:
02 4722 8840

Email:
info@stateoftheheart.com.au

Hours:
Monday, Tuesday - Friday
8:00 AM - 5:00 PM

Wednesday
8:00 AM - 3:00 PM

Saturday
By Appointment