Online Medical Booking Form – Sample Only "*" indicates required fields Applicant DetailsName* First Last Phone number*Date of birth* DD slash MM slash YYYY Email* Preferred Clinic Location*Please select from the drop-down menuQueanbeyanDeakinDirectorate or Department (if any)If AnyPosition title*Medical Components Required:* Standard Pre-employment Medical (example only) Audiometry (example only) Spirometry (example only) Instant Drug and Breath Alcohol (example only) Functional Assessment (example only) Appointment Details1st Suitable Date* MM slash DD slash YYYY 1st Suitable Time Hours : Minutes AM PM AM/PM 2nd Suitable Date* MM slash DD slash YYYY 2nd Suitable Time Hours : Minutes AM PM AM/PM 3rd Suitable Date* MM slash DD slash YYYY 3rd Suitable Time Hours : Minutes AM PM AM/PM Upload filesPlease upload any previous medical records, medical management plans, or any other relevant documentation.Max. file size: 200 MB.Please specify any special requirements
