Request an Appointment Company Please complete the form below and we will contact you shortly. First Name * Last Name * Date of Birth * Best Contact Number * Email * Would you like to proceed with your referral and book an appointment with the Oxford Clinic? * Yes No What are your main concerns? * Are you currently seeing a Psychologist or Psychiatrist? * Have you seen a Psychologist or Psychiatrist before? * If yes, who is/was your previous Psychologist/Psychiatrist? * Are you currently taking any medication? * What are you best days and times for appointments? * I am flexible with my availability Monday Tuesday Wednesday Thursday Friday Saturday Is there anything else we need to know about your availability? * Do you have a preference with who you see? * Whoever you suggest Dr. Ben Duke Dr. Catherine Benson Dr. Jon Paul Teo Dr. Maia McFadden Dr. Sagir Parkar Dr. Vinit Sawhney How did you hear about us? * Payment Deposit I am aware that I will need to pay a $220 deposit when booking my first appointment at Oxford Clinic Full Fee I understand that The Oxford Clinic is a full fee clinic, does not bulk bill and there will be an out of pocket expense for each appointment. WorkCover I understand that if I am under Work Cover I will still be required to pay for my appointments, and can then claim some of this back from WorkCover. referralGP I understand a referral from my GP is required to be able to claim Medicare rebates and to book my first appointment. Useful Links
