Request Appointment

Complete the form below to receive a callback from one of our representatives confirming your appointment request. Alternatively, you can call 800203 from 7:00 AM to 10:00 PM daily to speak to a representative.

If you have a medical emergency, call 999.

Requester Information

Who is this appointment for?

Self Other

Patient Information

Please provide patient information as it appears on legal documents.

Have you previously received care at Healthpoint?

The name of a parent is required if the patient is under the age of 16.

Medical Concern

What is the primary medical problem or diagnosis for the appointment request?

Important: After submission, please do not leave this form until you see the confirmation message.