Appointment Request VORLHNS

Title *

First Name *

Last Name *

Phone Number *Please enter Area Code if proving a Landline number

Email Address

Is the appointment for you or your child? *

MyselfMy child

Has a hearing test been done?

YesNo

Which is your preferred location to be seen?

Holmesglen Private HospitalWonthaggi Hospital ** Currently Unavailable Due to equipment issues Phillip Island Health Hub **Currently Unavailable Due to equipment issues

Do you have a Referral?You need a referral to be eligible for Medicare Rebate. Not having a referral may also impact your ability to claim for inpatient services from both Medicare and Private Health Insurers.

You may upload your Referral here.

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Message or Comment

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