Lakes Radiology: Online Appointment Request

Appointment Request

ONLINE BOOKING REQUEST

Our Booking Team is here to make arranging your appointment as easy as possible. Simply complete the form below and we’ll review your request, confirm a suitable appointment, and provide any preparation instructions or additional information you may need.

Please note: This form is an appointment request only and does not guarantee a confirmed appointment time. If you require immediate assistance, please contact us on (02) 4973 3732.

First Name

Last Name

Date of Birth (DD/MM/YYYY)

Gender

Is your appointment related to a workplace injury?

Yes No

Service

Date - first preference (DD/MM/YYYY)

Time - first preference

Date - second preference (DD/MM/YYYY)

Time - second preference

Phone number

Email address

Copy of referral #1 (Scan or take a photo of your referral and upload it here)

Copy of referral #2 (Scan or take a photo of your referral and upload it here)

Other information

By submitting this request, I understand that if I have flu-like symptoms on the day of my appointment, I will be required to reschedule.

My Health Record Notice: From 1 July 2026, pathology and diagnostic imaging providers are generally required to upload results to My Health Record by default. Please note: Our practice has been granted an extension to implement this requirement. During this time, your diagnostic imaging reports and results will not be uploaded to My Health Record. If you have any questions, please speak with a member of our team.