JHH Outpatients General Enquiry Form

Due to a high volume of enquiries, please allow up to 5 business days for a response. We may respond to you via email, phone or text

If you're enquiry is urgent, please call the JHH Outpatient Service Contact Centre on 02 49223912 option 4. DO NOT use this form for appointment enquiries/cancellations scheduled within 48 hours

Patient Details

Surname *

First Name *

Date of Birth *

Medical Record Number (if known)

Email *

Email Consent * Do you consent for all JHH Outpatient Correspondence, including appointment letters, to be sent to you via email?

Best contact phone number *

Reason for Enquiry

Reason for Enquiry *

DO NOT USE THIS FORM FOR APPOINTMENT CHANGES/CANCELLATIONS WITHIN 48HOURS.

Reschedule appointment requests- Please strongly consider attending your scheduled appointment. The next available appointment may not be for several months. By requesting to reschedule your appointment you accept that your new appointment might be outside the timeframe requested by the specialist team.

Please provide some more information about your enquiry *

Does your enquiry relate to a particular specialty? Please note, if your speciality is NOT listed, the JHH Outpatient Service does not manage these appointments or enquiries. Please visit our Speciality Clinic page for the correct contact pathways.

Specialty Service *

Does the patient have an upcoming scheduled appointment in the JHH Outpatient Service? Please specify date and time

Attachment Upload any relevant documents here

Who is completing this enquiry form (if not patient listed above)

Form completed by

Relationship to patient