Dr Glenn & Partners Online Request Form

Appointment Request

REQUEST YOUR APPOINTMENT

We’re committed to making your appointment request as simple and convenient as possible. Complete the form below and our Booking Team will contact you to confirm a suitable appointment, ensure the requested examination is correct, and provide any preparation instructions if required.

Please note: This is an appointment request only and does not guarantee a confirmed appointment time. If you require immediate assistance, please contact the clinic directly.

First Name

Last Name

Date of Birth (DD/MM/YYYY)

Gender

Service

Practice

Date - first preference (DD/MM/YYYY)

Time - first preference

Date - second preference (DD/MM/YYYY)

Time - second preference

Phone number

Email address

Is your appointment related to a workplace injury?

Yes No

Copy of referral #1 (Scan or take a photo of your referral and upload it here)

Copy of referral #2 (Scan or take a photo of your referral and upload it here)

Other information

By submitting this form, I acknowledge that I will need to reschedule if I have flu-like symptoms on the day of my appointment.

My Health Record Notice: From 1 July 2026, pathology and diagnostic imaging providers are generally required to upload results to My Health Record by default. Please note: Our practice has been granted an extension to implement this requirement. During this time, your diagnostic imaging reports and results will not be uploaded to My Health Record. If you have any questions, please speak with a member of our team.

Appointment Request

REQUEST YOUR APPOINTMENT

Kogarah

Wollongong

Rockdale