ACT Government Medical Booking Form - Aspen Corporate Health

Applicant Details

Name*

First Last

Phone number*

Date of birth*

Email*

Preferred Clinic Location*

Please select from the drop-down menu

Directorate*

Please ensure to select the directorate from the drop-down list

Position title*

Please upload your Job Description (JD) in either pdf or word document (NOT the Letter of Offer with salary). If you do not have a JD, please ensure to request one from your recruiter. Without JD, your booking will not be proceeded.

Accepted file types: pdf, docx, docmx, docb, dotm, doc, Max. file size: 200 MB.

Recruiter Email*

AGS Number (if known)

Invoice to be sent to (email address)*

Medical Components Required*

Appointment Details

Available dates from:*

Available dates to:*

Preferred appointment times*

Please specify any special requirements

Upload files

Please upload any previous medical records, medical management plans, or any other relevant documentation.

Max. file size: 200 MB.

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