Professional Webform

Welcome to our specialised form designed for the dedicated professionals shaping the future of healthcare. Whether you’re a General Practitioner or a Speech Pathologist, this platform is tailored to cater to your unique needs. Please provide the necessary details below, ensuring that all information is accurate and up-to-date, so we can serve you better and further the cause of comprehensive patient care.

Come visit or talk to us

Call us at

07 3841 3764

Fax number

07 3841 3147

Message Or Visit Us

Opening Hours

Open Monday to Friday
8:30am – 5pm
Saturday 9am-12pm by appointment only.

Visiting Hearing Clinics

Springfield Lakes
Metro Medical Centre, 30/1 Springfield
Lakes Blvd, Springfield Lakes

Waterford West
Waterford West 7 Day Medical Centre Cnr Kingston & Tygum Rds Waterford West

Calamvale
Calamvale Family Practice Cnr Beaudesert Rd & Nottingham Rd

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Professional Webform for GPs and Speech Pathology

Client Name

Date

Contact Number

Clinical History

Referring GP

GP Provider Number

Please choose the test you require for your patient in the selection box below.

If you chose 'Custom Earplugs' above the selection box, please select the type of Custom Earplugs you require below.

Noise (solid plug – best protection against noise). Musician (filtered plug) Swimming (good for those with grommets or recurrent otitis media) Other

Message

I CONFIRM THAT ALL INFORMATIONS ARE CORRECT. We're committed to ensuring that your information is accurately recorded. Please review the form for accuracy and that all details are correct. Should there be any discrepancies or if you need to update any information, please call us immediately. We value the precision and care you bring to your profession, and we strive to reflect that in our records.