ABF Medical Request Form "*" indicates required fields Choosing the wrong medical or fitness assessment type will only delay the booking progress, incur additional charges to the department and you may end up repeating the whole medical or the fitness test. Before choosing your assessment types, please ensure to consult with your employer and read the guidelines below. Once you have undertaken the following Medicals and the fit slip is approved, you will need to undertake your fitness assessment. If you undertake the following Basic Medicals, please see the correct fitness assessment you need to select from the drop-down list. • BFO Basic Medical => Fitness type: Basic Fitness Assessment (BFA) • BFO Basic Medical - Over 55 Years => Fitness type: Basic Fitness Assessment (BFA) • Container Examination Facility (CEF) Medical with Fitness to wear respiratory=> Fitness type: Basic Fitness Assessment (BFA) If you undertake the following Use of Force Medicals, please see the correct fitness assessment you need to select. • Use of Force Medical => Fitness type: Functional Fitness Assessment (FFA) • Use of Force Medical - Over 55 years => Fitness type: Functional Fitness Assessment (FFA) If you undertake the following Enforcement Medicals, please see the correct fitness assessment you need to select. • Basic Medical Assessment (Marine) => Fitness type: Basic Fitness Assessment (Marine) • Use of Force Medical Assessment (Marine) => Fitness type: Functional Fitness Assessment (Marine)• Basic Medical Assessment (Marine) - Over 55 Years Old=> Fitness type: Basic Fitness Assessment (Marine) • Use of Force Medical Assessment (Marine) - Over 55 Years Old=> Fitness type: Functional Fitness Assessment (Marine)Type of request*Please select medical/fitness type from the following drop-down optionsBFO Basic MedicalBFO Basic Medical - Over 55 YearsBFO Basic Medical (MARINE)BFO Basic Medical - Over 55 Years (MARINE)Basic Fitness Assessment (BFA) - Step TestBasic Fitness Assessment (BFA) - Beep TestBasic Fitness Assessment (BFA) - Step Test (MARINE)Basic Fitness Assessment (BFA) - Beep Test (MARINE)Use of Force MedicalUse of Force Medical- Over 55 YearsUse of Force Medical (MARINE)Use of Force Medical – Over 55 Years (MARINE)Functional Fitness Assessment - FFAFunctional Fitness Assessment - FFA (MARINE)Container Examination Facility MedicalContainer Examination Facility Medical – Over 55 yearsContainer Examination Facility Medical with fitness to wear respiratorLead Health Surveillance Assessment (only with an ABF referral)Lead Blood Test (only with an ABF referral)Fit to Wear RespiratorCandidate name:* First Last Candidate work email* Candidate work phone number*Candidate personal email (optional) Candidate personal phone number (optional)Candidate date of birth* DD slash MM slash YYYY AGS Number*Preferred location for Assessment*ACT Belconnen (Fitness only)ACT Gunghalin (Fitness only)ACT Woden (Fitness only)ACT Queanbeyan (Medical only)NSW Bankstown (Both Medical and Fitness)NSW Baulkham Hills (Both Medical and Fitness)NSW Brookvale (Fitness only)NSW Charlestown (Fitness only)NSW Chatswood (Fitness only)NSW Dapto (Both Medical and Fitness)NSW Goulburn (Fitness Only)NSW Mount Druitt (Both Medical and Fitness)NSW Narellan (Both Medical and Fitness)NSW Newcastle (Both Medical and Fitness)NSW Shellharbour (Fitness Only)NSW Warrawong (Both Medical and Fitness)NSW Waterloo (Both Medical and Fitness)NSW Wetherill Park (Both Medical and Fitness)NSW Wollongong (Both Medical and Fitness)NT Darwin City (Both Medical and Fitness)QLD Banyo (Fitness Only)QLD Bardon (Fitness only)QLD Beenleigh (Both Medical and Fitness)QLD Brikdale (Fitness Only)QLD Brisbane CBD (Medical only)QLD Brown Plains (Medical only)QLD Bundaberg (Both Medical and Fitness)QLD Cairns (Both Medical and Fitness)QLD Chermside (Both Medical and Fitness)QLD Currajong (Medical only)QLD Geebung (Medical)QLD Gladstone Central (Fitness only)QLD Hendra (Fitness only)QLD Jindalee (Fitness only)QLD Loganholme (Medical Only)QLD Manunda (Fitness Only)QLD Maryborough (Fitness only)QLD Mermaid Beach (Both Medical and Fitness)QLD North Mackay (Both Medical and Fitness)QLD Oxley (Both Medical and Fitness)QLD Southport (Both Medical and Fitness)QLD Townsville (Medical only)QLD Victoria Point (Fitness Only)QLD Westcourt (Medical Assessment Only)QLD West End (Fitness Only)SA Gillman (Medical Only)SA Mile End (Both Medical and Fitness)SA Elizabeth (Both Medical and Fitness)SA Modbury (Both Medical and Fitness)TAS Hobart (Both Medical and Fitness)TAS Launceston (Both Medical and Fitness)TAS Lindisfarne (Both Medical and Fitness)TAS Newstead (Medical Only)VIC Epping (Both Medical and Fitness)VIC Geelong (Both Medical and Fitness)VIC Highett (Both Medical and Fitness)VIC Melton (Fitness Only)VIC Moonee Ponds (Both Medical and Fitness)VIC Mulgrave (Medical only)VIC Narre Warren (Both Medical and Fitness)VIC Port Melbourne (Medical Only)VIC Ringwood (Both Medical and Fitness)VIC Shepparton (Fitness Only)VIC Werribee (Both Medical and Fitness)WA Albany (Both Medical and Fitness)WA Boulder (Both Medical and Fitness)WA Broome (Both Medical and Fitness)WA Bunbury (Both Medical and Fitness)WA Cannington (Both Medical and Fitness)WA Craigie (Fitness only)WA Geraldton (Both Medical and Fitness)WA Karratha (Both Medical and Fitness)WA Morley (Fitness only)WA Port Hedland (Both Medical and Fitness)WA Rockingham (Both Medical and Fitness)Once confirmed your three most suitable dates and if fits the clinic’s availability, the booking confirmation will be made without confirming with the BFO again through a phone call or e-mail address. The BFO should therefore be willing to attend the booked appointment based on the provided suitable availability In case of rescheduling or cancelling your appointment, please inform us at least 24 hours in advance to avoid late cancellation fees. Please reach out to the following contact details: For Medical Enquiries: 02 6203 9221 – Anita Karki, For Fitness Enquiries: 02 6122 2921 – Laxmi Basnet or E-mail: [email protected]1st Suitable Date* DD slash MM slash YYYY 1st Suitable Time* Hours : Minutes AM PM AM/PM 2nd Suitable Date* DD slash MM slash YYYY 2nd Suitable Time* Hours : Minutes AM PM AM/PM 3rd Suitable Date* DD slash MM slash YYYY 3rd Suitable Time* Hours : Minutes AM PM AM/PM This field is hidden when viewing the formAvailable from: DD slash MM slash YYYY Please indicate your availability for a medical assessment appointment.This field is hidden when viewing the formAvailable to: DD slash MM slash YYYY This field is hidden when viewing the formIf availability is limited within the above date range, please further indicate availability below. If left blank, ACH will assume you are available any time within the date range provided above.If availability is limited within the above date range, please further indicate availability below. If left blank, ACH will assume you are available any time within the date range provided above. Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Additional commentsDeclaration* I declare, that the requested assessment is the correct type of Assessment that is required for my current ABF role.Declaration* I acknowledge and consent that my personal information may be used and/or disclosed by Aspen Medical for the sole purpose of booking medical assessment*Please remember to bring a valid photo ID such as a driver's license or ABF ID card to your appointment as it is required by the clinic. If booking medical assessment with Aspen Medical, fitness needs to be booked with the same provider, Aspen Medical also.