Request an Appointment

Fill in your details below and our team will be in touch to offer you the next available appointment with one of our dermatologists.

Patient Details

First Name *

Last Name *

DOB *

Email Address *

Phone Number *

Street Address *

Suburb *

Post Code *

Appointment Details

Preferred Location *

RowvilleRingwoodEither

Do you have a referral? *

YesNo

If you have a referral, please do not proceed with submitting this form. Instead, please upload your referral to our portal using the link below. We will then get back to you with your appointment options.

Upload your referral here --> https://dermatology.melbourne/referral/

I understand that whilst I may be offered an appointment with a dermatologist, a Medicare rebate will not be applicable without a referral from a GP or other medical specialist.

Please provide details of your usual GP *If you do not have a regular GP, please nominate one, as this is an essential requirement to see a doctor without a GP referral.

Reason for Visit *

By submitting this enquiry form, you agree to our Privacy Policy and acknowledge that a response will not constitute medical advice, diagnosis, or treatment and will be used to assist in arranging an appointment only. *

This enquiry form is not be used for urgent or emergency medical situations. If you are experiencing a medical emergency or require urgent care, please call 000 immediately or proceed to the nearest hospital emergency department. *

I consent to being contacted by phone, SMS or email. *

Custom response *

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