Please use the form below to request an appointment and our friendly team will be in touch to confirm availability. Your Details Title MrMissMrsMsDrProfOther First Name Surname Phone Email Do you have a referral? If you have a referral, please take a photograph using your mobile phone or attach a scanned copy of this. Attach your referral Date of birth (dd/mm/yyyy) Examination request Preferred clinic Woodville Clinic, Woodville Salisbury Clinic, Salisbury Flinders Private Hospital, Bedford Park - Flinders Private Parkside Clinic, Parkside Brighton Clinic, Brighton Campbelltown Clinic, Campbelltown Stirling Hospital, Stirling Calvary Central Districts Hospital, Elizabeth Vale Marion Medical Centre, Marion Calvary Hospital, North Adelaide - Calvary Hospital The Memorial Hospital, North Adelaide - The Memorial Hospital Port Adelaide Clinic, Port Adelaide Radiology SA House, Kent Town - Administration only Victoria Park, Dulwich Covid-19 Yes No Are you under any SA Health directive to self-isolate or quarantine? Yes No Are you awaiting Covid-19 test results? Yes No Do you have any Covid-19 symptoms? reCAPTCHA Submit