Appointment Request

If you have not received contact from us after 48 hours, please phone (08) 9387 9888 to confirm your appointment details.

Appointment Type*

GP referral - Preferred pathway
General appointment - No referral needed
Teletherapy service

Location*

Please select your preferred location. Not all services are available at all locations. Please note general appointments are not available at our Karratha location.

If your patient is eligible for the Medicare subsidy under the GP Chronic Care Management Plan and Team Care Arrangement, please fill in the following forms and submit them to us instead of requesting a general appointment.

Steps:

Click Here to download the combined referral and care plan forms.
Complete the forms and attach a copy in an email.
Click Here to pre fill your email.

Parent/Guardian Name*

First name Surname

Email*

Phone number*

Appointment for

Adult Appointment

Child's name

Child's first name Child's surname

Child's date of birth

Gender

Male
Female

Appointment regarding*

Please select an option:

Add more details or comments about your request

How did you hear about Telethon Speech & Hearing?*

Please specify how you heard about Telethon Speech & Hearing.

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Appointment Request

Appointment Request

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