Request for Medical and Paramedical services


Please fill in the form below to request our services.

NB: All fields are required to process this form.


Date:
Client Name:
Sex: Male Female
Date Of Birth:
Address:
State:
Postcode:
Phone Number (home):
Phone Number (mobile):
   
Insurance Company:
App. No:
Agent's Name:
Agent's Email:
Agent's Phone:

Tests Required (please tick)
HIV
MBA
HDL, LDL
Hepatitis B antigen
Hepatitis C antibody
Micro-urine
FBC, ESR
Serum Cotinine
Resting ECG
Paramedical
Quick / Fast Check
GP Medical
Specialist Medical with Resting ECG
Stress (exercise) ECG

Please enter any other requirements:

Please call us on 02 9559 4974 if you need help filling out this form.

  • Full range of insurance medical and paramedical services available

  • Our highly professional mobile service includes registered nurses, pathology collectors, Specialists and GPs

  • Clients are contacted within 24 hours of receiving request

  • Results are forwarded to the insurance company in 24 to 48 hours

  • Services available across Australia

  • Call us any time of the day or night

 

 




 
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