MAKING AN ONLINE APPOINTMENT WITH HHMP - SYDNEY PRACTICE ONLY

Please fill in the attached form and press SEND to email If sent during normal business hours (Mon-Fri 8:00 am -7:00 pm & Sat 9:00 -1:00) a response will be sent within two hours. If email sent outside of business hours a response will be sent first thing the next business day. Upon receipt of your email request during business hours we will contact you to advise whether your request has been accepted or to suggest alternatives. (Please note our cancellation fee policy below) This service is NOT available for same day appointments. This service is currently available ONLY for our Sydney Medical Practice. PREFERENCES (not guaranteed) Day of Appointment No Preference Monday Tuesday Wednesday Thursday Friday Saturday   Any 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   No Preference January February March April May June July August September October November December Doctor Sex of Doctor No Preference Dr Mark BLOCH Dr Dick QUAN Dr David AUSTIN Dr Andrew GOWERS Dr Kate BESSEY Dr Gail LYNEHAM Dr Ercel OZSER Dr Hsin-Hua LIU Dr Jane HUNT Dr Caroline WEST WARNE Dr Juliette LITTLE Dr Davina HILEY M F Time of appointment Opening Hours Any 8:00 am 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 pm 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45    AM    PM  M - F: 8am to 7pm (last appt 6.45pm) Sat: 9am to 1pm (last appt 12.45pm)   Note: Some appointments may take more than 15 minutes (ie. pap smear). If you believe you may need an extended appointment, please provide your requirements/details here. CONFIDENTIAL PATIENT QUESTIONNAIRE Note: Please fill in all fields. Fields marked with * are required. PATIENT INFORMATION   * Patient's Family Name: * First Name: Mr. Miss Mrs. Ms.     Dr. Is this your preferred name? If no, fill in "Preferred Name" field. Yes No Preferred Name:   * Birth Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 * Age: * Sex: M F   Street Address: Suburb: P.O Box: Postcode: City:   Home Phone: Work Phone: Mobile Phone: * Email:   * Preferred contact method: Mobile Phone Home Phone Work Phone Email Medicare Numer: Expiry Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2006 2007 2008 2009 2010 2011 2012     Govt. HCC/Pension/DVA Number: Expiry Date:   Security Code: Bulk Billing Doctors We run a private practice but also offer bulk billing with specified doctors. There is greater flexibility in appointment scheduling with HHMP private doctors. When making an appointment please look at our Website and advise which Dr you want to see. Bulk Billing Appointments Not Available Saturday. Cancellation Fee In order to run the most efficient practice for our patients a small fee of $20.00 is charged for patients that do not show for their appointments or who cancel with less then two hours notice of their appointment time. This fee is at the discretion of your HHMP doctor. Appointment Fees Appointment fees are based on length and complexity of appointments and are at the discretion of the treating doctor. Most consults range between $60.00 to $110.00 dollars of which a major part of the cost is refunded by Medicare. Procedures such as removal of sunspots, ECG's, breathing tests, allergy tests etc will carry additional charges which are also partly refunded by Medicare Medicare Rebate Patients with a Medicare card are charged a fee and are eligible for a Medicare rebate which the practice can process for you on your behalf. Rebate cheques are electronically deposited to your bank accounts by Medicare. Privacy Policy: Please note our Privacy Policy.