Request an Appointment Order Number 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 Dr. Narcisa Zemek 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
