Online Medical Consultation - National Medical Dental

Step 1 of 20

Strictly no Drugs of Addiction prescribed
If you need an appointment please call the practice on (02) 8834 7760 to make your booking over the phone.

This site is currently under maintenance and we are working on it.Thank you for your patience.

Available Services
Quick Prescription Service for a repeat prescription/medication you already know (Fee $19.95 if not Bulk Billed)
Absence From Work Certificate For certificates to cover more than 1 day, please book a“Telehealth GP Appt” instead (Fee $19.95 if not Bulk Billed)
Telehealth GP Appointment- 10 Mins (General Consults, Prescriptions, Absence From Work Certificate, Referral to Specialists/Allied Health, Referral for Blood Tests and X-rays) (Strictly no Drugs of Addiction prescribed) (No Vaccine Exemption certificate issued under this appointment type) (Fee $40.50 if not Bulk Billed)
Telehealth GP Long Consult- 25 Mins (General Consults, Prescriptions, Absence From Work Certificate, Referral to Specialists/Allied Health, Referral for Blood Tests and X-rays) (Strictly no Drugs of Addiction prescribed) (No Vaccine Exemption certificate issued under this appointment type) Fee $97.85 (this appt type is not bulk billed)
COVID-19 Vaccine Exemption Certificate Fee $77.25 (this appt type is not bulk billed)
Telehealth Psychologist Appointment (50 Mins - Fee $168 if not Bulk Billed)
Telehealth Dietitian Appointment (60 Mins - Fee $180 if not Bulk Billed)

Available Services

Quick Prescription Service

for a repeat prescription/medication
you already know

(Fee $19.95 if not Bulk Billed)

Absence From Work Certificate

For certificates to cover more than 1 day,
please book a“Telehealth GP Appt” instead

(Fee $19.95 if not Bulk Billed)

Telehealth GP Appointment- 10 Mins

(General Consults, Prescriptions,
Absence From Work Certificate,
Referral to Specialists/Allied Health,
Referral for Blood Tests and X-rays)

(Strictly no Drugs of Addiction prescribed)
(No Vaccine Exemption certificate
issued under this appointment type)
(Fee $40.50 if not Bulk Billed)

Telehealth GP Long Consult- 25 Mins

(General Consults, Prescriptions,
Absence From Work Certificate,
Referral to Specialists/Allied Health,
Referral for Blood Tests and X-rays)

(Strictly no Drugs of Addiction prescribed)
(No Vaccine Exemption certificate
issued under this appointment type)
Fee $97.85 (this appt type is not bulk billed)

COVID-19 Vaccine Exemption Certificate

Fee $77.25 (this appt type is not bulk billed)

Telehealth Psychologist Appointment

(50 Mins - Fee $168 if not Bulk Billed)

Telehealth Dietitian Appointment

(60 Mins - Fee $180 if not Bulk Billed)

Are you a new patient to our practice?*
- Yes
- No

We are committed to protecting your privacy and know it is important for you to understand how your information is handled.
In submitting the information contained in this form, you:*
Acknowledge that your health practitioner and National Telemedicine Doctors will collect such information (including any personal or sensitive information), for the purposes of providing you with health services or enabling any related communications; and
Consent*
Consent to National Telemedicine Doctor’s Terms & Conditions, and to National Telemedicine Doctors handling your personal and sensitive information in accordance with its Privacy Policy.*

To complete this form you may need:
- Medicare card
- Pension/Healthcare/Concession card
Please make sure you have any relevant items ready before you begin.

To protect your personal information this form will clear and reset after 4 minutes of inactivity.

All fields marked with an asterisk (*) are required.

Personal Details
Title
First name*
Last name*
Preferred name
Gender*
- Female
- Male
Date of birth*

DD
MM
YYYY
Occupation
Street address*
Street address line 2
Suburb*
State*
Postcode*
Email address*
Home phone

Health Initiatives
In order to assist us with health initiatives and tailor care
Do you identify as Aboriginal or Torres Strait Islander?*
- Yes
- No
Please select what you identify as*
- Aboriginal
- Torres Strait Islander
- Aboriginal/Torres Strait Islander
What is your country of birth
Medical Information
Medicare card
Do you have a medicare card?*
- Yes
- No
Medicare card - Number*
Medicare card – Position on card*
Medicare card – Expiry date*

DD
MM
YYYY
DVA card
Do you have a DVA card?
- Yes
- No
DVA Card - Type*
- Gold
- White
DVA Card – Expiry date*

DD
MM
YYYY
Pension/Health Care Card
Do you have a Pension/Health Care card?
- Yes
- No
Pension/Health Care Card – Number*
Pension/Health Care Card – Ref*
Pension/Health Care Card – Expiry date*

DD
MM
YYYY

Emergency Contact Information
We collect this information in case of an emergency
Next of kin
Next of kin – First name*
Next of kin – Last name*
Next of kin – Relationship*
Next of kin – Contact number*
Emergency contact
Same as Next of kin
- Same as Next of kin
Emergency contact – First name*
Emergency contact – Last name*
Emergency contact – Relationship*
Emergency contact – Contact number*

Your Health History
Do you have any allergies or are you sensitive to drugs or dressings*
- Yes
- No
Please list*

Social Activities
Do you smoke?*
- No
- Yes
- Ex Smoker
How frequently do you smoke? (eg 2 cigarettes daily/weekly)*
If you’re an ex smoker, can you please provide the approximate date that you ceased smoking?*

DD
MM
YYYY
Do you drink alcohol?*
- No
- Yes
How often do you have a drink containing alcohol?*
How many standard drinks containing alcohol do you have on a typical day?*
How often do you have six or more drinks in one occasion?*
Are you concerned about drinking?*
- Yes
- No

Verification required to use this service
To use this service, we need to confirm you are a genuine person by sending you a verification code. Please enter your mobile phone number and click the “VERIFY” tab below to receive a 6 digit code sent to your mobile number, and then enter the code when prompted to -
Verified Phone Number*

Which service do you require today?
Please choose carefully from the following appointment categories – any appointment category chosen incorrectly will be declined.
Quick Prescription Service

for a repeat prescription/medication
you already know
(Fee $19.95 if not Bulk Billed)
Absence From Work Certificate

For certificates to cover more than 1 day,
please book a "Telehealth GP Appt" instead
(Fee $19.95 if not Bulk Billed)
Telehealth GP Appointment- 10 Mins

(General Consults, Prescriptions,
Absence From Work Certificate,
Referral to Specialists/Allied Health,
Referral for Blood Tests and X-rays)

(Strictly no Drugs of Addiction prescribed)
(No Vaccine Exemption certificate
issued under this appointment type)

( Fee $40.50 if not Bulk Billed)
Telehealth GP Long Consult- 25 Mins

(General Consults, Prescriptions,
Absence From Work Certificate,
Referral to Specialists/Allied Health,
Referral for Blood Tests and X-rays)

(Strictly no Drugs of Addiction prescribed)
(No Vaccine Exemption certificate
issued under this appointment type)

Fee $97.85 (this appt type is not bulk billed)
COVID-19 Vaccine Exemption Certificate

Fee $77.25 (this appt type is not bulk billed)
Telehealth Psychologist Appointment

(50 Mins - Fee $168 if not Bulk Billed)
Telehealth Dietitian Appointment

(60 Mins - Fee $180 if not Bulk Billed)
*
- Quick Prescription Service
- Absence From Work Certificate
- Telehealth GP Appointment- 10 Mins
- Telehealth GP Long Consult- 25 Mins
- COVID-19 Vaccine Exemption Certificate
- Telehealth Psychologist Appointment
- Telehealth Dietitian Appointment

Absence From Work Certificate
Please answer the questions below:
01. Are you unwell and too ill to attend work today?*
- Yes
- No
02. Have you had symptoms or an illness like this before?*
- Yes
- No
03. Do you intend to see a doctor if your symptoms are not improving by tomorrow?*
- Yes
- No
04. Are you experiencing any of the following symptoms: severe pain in the head or abdomen, fever above 39 degrees, repeated vomiting or vision disturbances?*
- Yes
- No
05. Do you suffer any chronic medical conditions?*
- Yes
- No
One of our Australian registered doctors will review your answers and may contact you directly should further information be required. If your request is approved, we will email your Absence From Work Certificate directly to you.

Medicine Category:

Sub-category: NA

Sub- sub category: NA

Selected Medicine:

Requested Medication Details:

Answers to the questions asked-

Select Medicine Category

Select a sub-category

Select a sub- sub category

Select Your Medication

Requested Medicine

Please answer the questions below:

Preferred Pharmacy
In the event that a doctor prescribes a prescription to a patient, that prescription will be sent by the doctor electronically either to the patient as an ePrescription or a registered Australian pharmacy of the patient’s choice, or if the patient does not specify a pharmacy, it will be sent to an Australian accredited pharmacy situated in an area close to the patient’s home. The pharmacy will then dispense the medication.
Pharmacy name
Pharmacy address
Pharmacy contact phone
Pharmacy contact email

Bulk Billing Policy for GP Services
If you have a valid Medicare card and like to have a Bulk Bill Appointment with one of our Bulk Billing doctors please tick one of the following reasons if applicable -
If you have a valid Medicare card and like to have a Bulk Bill Appointment with one of our Bulk Billing doctors please tick one of the following reasons if applicable -
- I am currently subject to COVID-19 public health orders requiring quarantine.
- I am currently subject to COVID-19 public health orders requiring isolation.
- I am homeless because I am going through an extreme form of poverty due to the inadequacy of income, health care supports and social supports.
- I am requesting the service for a child under the age of 12 months.
- I am a patient of a medical practitioner at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.
- I am currently living in a flood-affected area, defined as a State or Territory local government area which is currently declared as a natural disaster area due to flood by a State or Territory Government.
If you have not ticked any of the boxes above, then you are not eligible for bulk billing for any of our GP services and you will be charged a private fee of $19.95.

If you are eligible for bulk billing, your doctor/health practitioner will call you at the appointment time (as soon as he/she is available) on the telephone number that is registered with us as your contact phone number. If it is a video consultation, we will provide you with instructions to join the video call. You will need to call back immediately if you miss the call.
If you have not ticked any of the boxes above, then you are not eligible for bulk billing for any of our GP services and you will be charged a private fee of $40.50

If you are eligible for bulk billing, your doctor/health practitioner will call you at the appointment time (as soon as he/she is available) on the telephone number that is registered with us as your contact phone number. If it is a video consultation, we will provide you with instructions to join the video call. You will need to call back immediately if you miss the call.

Bulk Billing Psychologists
If you have a valid Medicare Card and referral from a GP through a Mental Health Care Plan (MHCP) and you wish to have a Bulk Bill appointment with one of our Psychologists please tick below to confirm -
If you have a valid Medicare Card and referral from a GP through a Mental Health Care Plan (MHCP) and you wish to have a Bulk Bill appointment with one of our Psychologists please tick below to confirm -
- I have a valid Medicare Card and referral from a GP through a Mental Health Care Plan (MHCP).
Please email us a copy of your referral (Care Plan) at admin@national-medical-dental.com before booking an appointment. If you are not eligible for bulk billing, the fee for a Standard Telehealth Consult (50 mins) with one of our Psychologists is $168.

Bulk Billing Dietitians
If you have a valid Medicare Card and referral from a GP through a Chronic Disease Management Plan (CDMP) and you wish to have a Bulk Bill appointment with one of our Dietitians please tick below to confirm -
If you have a valid Medicare Card and referral from a GP through a Chronic Disease Management Plan (CDMP) and you wish to have a Bulk Bill appointment with one of our Dietitians please tick below to confirm -
- I have a valid Medicare Card and referral from a GP through a Chronic Disease Management Plan (CDMP)
Please email us a copy of your referral (Care Plan) at admin@national-medical-dental.com before booking an appointment. If you are not eligible for bulk billing, the fee for a Standard Telehealth Consult (60 mins) with one of our Dietitians is $180.

Please upload below a copy of your COVID-19 (PCR test or RAT test) result :

(Files must be less than 2 MB. Allowed file types: pdf, png and jpg)
Attach File*
Drop files here or

Accepted file types: pdf, jpg, png, jpeg.
Also, upload below a copy of evidence of the registration of your result with relevant state health department :
Attach File*
Drop files here or

Accepted file types: pdf, jpg, png, jpeg.
Please note:

The maximum period of exemption following a confirmed SARS-CoV-2 infection is 4 months from the date of diagnosis.

(Must be confirmed with PCR test OR RAT test that has been registered with relevant state health department)

The Australian Immunisation Register is linked to your Medicare records. You can access your exemption either through your my.gov.au account or by downloading the Medicare app to your phone - navigate to the section marked “Proof of vaccinations”.

The ATAGI advice is not that it’s recommended to withhold vaccination following a SARS-CoV-2 infection.

ATAGI strongly recommends that all eligible Australians receive their full course of vaccination.

The temporary vaccine exemption following infection is simply a recognition that there will be a period of natural immunity following infection.

Source
How Did You Hear About Us?
Please specify
Communication
I consent to receive SMS reminders, messages and emails*
- Yes
- No

Privacy and Terms
Please sign (using your finger or computer mouse) or place your electronic signature in the box below to confirm that you have read and agree to our “Terms & Conditions” and “Privacy Policy” and that all the information you have provided us in this form is true and correct to the best of your knowledge and belief.
Signature*
You are not Eligible for Bulk Billing for this consultation.

Based on the information you have provided us it appears that you are not eligible for bulk billing for this consultation. If you wish to proceed you must pay the fee of $19.95 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
You are not Eligible for Bulk Billing for this consultation.

Based on the information you have provided us it appears that you are not eligible for bulk billing for this consultation. If you wish to proceed you must pay the fee of $40.50 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
This appointment type is not bulk billed.

If you wish to proceed you must pay the fee of $97.85 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
This appointment type is not bulk billed.

If you wish to proceed you must pay the fee of $77.25 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
You are not Eligible for Bulk Billing for this consultation.

Based on the information you have provided us it appears that you are not eligible for bulk billing for this consultation. If you wish to proceed you must pay the fee of $168 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
You are not Eligible for Bulk Billing for this consultation.

Based on the information you have provided us it appears that you are not eligible for bulk billing for this consultation. If you wish to proceed you must pay the fee of $180 using our automated secure payment method before hitting the “Next” button below. Please click on the "Pay with Debit/Credit Card or PayPal" button below to proceed -
Now click “Next” below to
choose a Practitioner & Time

Step 1 of 20

Strictly no Drugs of Addiction prescribed

If you need an appointment please call the practice on (02) 8834 7760 to make your booking over the phone.

Personal Details

Health Initiatives

Medical Information

Medicare card

DVA card

Pension/Health Care Card

Emergency Contact Information

Next of kin

Emergency contact

Your Health History

Social Activities

Verification required to use this service

Which service do you require today?

Please choose carefully from the following appointment categories – any appointment category chosen incorrectly will be declined.

Quick Prescription Service

Absence From Work Certificate

Telehealth GP Appointment- 10 Mins

Telehealth GP Long Consult- 25 Mins

COVID-19 Vaccine Exemption Certificate

Telehealth Psychologist Appointment

Telehealth Dietitian Appointment

Absence From Work Certificate

Preferred Pharmacy

Bulk Billing Policy for GP Services

Bulk Billing Psychologists

Bulk Billing Dietitians

Please upload below a copy of your COVID-19 (PCR test or RAT test) result :

Also, upload below a copy of evidence of the registration of your result with relevant state health department :

Source

Communication

Privacy and Terms

You are not Eligible for Bulk Billing for this consultation.

You are not Eligible for Bulk Billing for this consultation.

This appointment type is not bulk billed.

This appointment type is not bulk billed.

You are not Eligible for Bulk Billing for this consultation.

You are not Eligible for Bulk Billing for this consultation.

Now click “Next” below to choose a Practitioner & Time

Search

Now click “Next” below to
choose a Practitioner & Time