Book a Bulk-Billed Appointment | Petersham Family Medical Centre

Request for a Bulk Billed Appointment

Step 1 of 19

Need a Bulk Billed Appointment ?

Click on this link Bulk Billing Criteria for GP Services to check your eligibility before requesting a bulk billed appointment by email.
You can SKIP filling out this form if:
- You’ve had at least one face-to-face service from any health professional at our practice in the last 12 months and now need a 10 min Telehealth/Phone Consult.
- You are already registered with us and want a face-to-face (in-person) consultation.
If you are in one of the above categories, simply call (02) 95608207 or email the practice to complete your booking by phone or email.

10 min Telehealth consults are bulk billed for all eligible patients.

If you are not in one of the above categories, you may still be eligible for a bulk billed appointment; please complete and submit this form for your eligibility to be assessed.

Click, the “Next” button below to proceed -

Bulk Billing Doctors’ Availability

Currently, the following doctors bulk bill, but only during their bulk billing work hours as shown below.
- Dr Hsien Lim - (Mon - Fri: 9am-4pm)
  (Available for both Face-to-Face & Phone consults)
- Dr Jeremy Stephenson – (Mon-Fri: 12noon -4pm)
  (Available for Phone consults only)
- Dr Charmi Vithanarachchi – (Tues: 2pm-9pm)
  (Available for Phone consults only)
If you are eligible for bulk billing, we can offer you a bulk billed appointment with the first available bulk billing doctor, and confirm your appointment via a text message or email.
Do you wish to proceed?*
- Yes
- No
Click “Yes” if you wish to proceed.

Which service do you require today?
Which service do you require today ?

(Please check once more the bulk billing Doctors’ availability before making your selection below).
Which service do you require today ?*
- 10 min Telehealth/Phone Consult with any Doctor
- 15 min In-Clinic Consult with Dr Hsien Lim
- 30 min In-Clinic Consult with Dr Hsien Lim
- 40 min In-Clinic Consult with Dr Hsien Lim
The following services cannot be bulk billed, for any patient.
- Telehealth GP Long Consult
- COVID-19 Vaccine Exemption Certificate
- Appointment with a Psychologist
- Appointment with a Dietitian
- Appointment with a Physiotherapist
- Appointment with a Podiatrist

Please tick the reason below for your eligibility for a bulk billing appointment (You must also have a valid Medicare card).

For Telehealth/Phone consults:
For Telehealth/Phone consults
- I need a Telehealth/Phone consult (not longer than 10 mins) AND I have visited Petersham Family Medical Centre in person for at least one face- to-face service from a health professional at the practice in the last 12 months. (If you are unsure, please contact the practice by phone or email and we will confirm this attendance).
- I am a patient who needs a consult to access mental health services.
- I am homeless because I am going through an extreme form of poverty due to the inadequacy of income, health care supports and social supports.
- I am requesting the service for a child under the age of 12 months.
- Patients of a medical practitioner at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service. (Please provide below details of this medical/health service or practice including service/practice name, address and contact details).
- I am a patient who needs a consult relating to blood borne viruses, sexual or reproductive health.
- People isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.
- People affected by natural disaster, defined as living in a local government area declared a natural disaster by a State or Territory government. (Please provide below relevant information/online news link/evidence or notification from your State or Territory local government to support your eligibility).
For face-to-face consults:
For face-to-face consults:
- I am a DVA Gold Card holder who requires a face-to-face consult.
- I am a child under 16 years of age who requires a face-to-face consult.
- I require a face-to-face consult for an eligible Health assessment, such as a 40-49 years old health check (allowed once annually), seniors check (for patients aged 75 plus, allowed once annually), or for a Domiciliary Medication Management Review for patients on 5 or more medications (subject to eligibility).
- I require a face-to-face consult for a Care Plan (subject to eligibility).
- I require a face-to-face consult for a follow up consultation for test results or review.
If we have asked for relevant information or evidence to support your eligibility, please enter/upload it below:*
Untitled*
Attach File
Drop files here or

Accepted file types: jpg, gif, png, pdf.
Accepted file types: pdf, jpg, png, jpeg.
(Files must be less than 2 MB. Allowed file types: pdf, png and jpg)

IMPORTANT

If you do not provide us with the details or attach evidence, if we requested above, to support your eligibility, we unfortunately cannot offer you any appointment for a bulk billed consult with any of our bulk billing doctors unless you pre-pay for the consult

Regarding Cancellation/Non Attendance

If you request and are confirmed for a bulk-billed appointment, but do not attend the appointment when one of our doctors contacts you, we unfortunately cannot offer you another future bulk-billed appointment.
Do you wish to proceed?*
- Yes
- No
Click “Yes” if you wish to proceed.

Regarding doctor’s availability -

Due to high demand, our doctors have a high workload at certain times, but will endeavour to be available at your chosen appointment time, or as close to your appointment time as is possible.
Do you wish to proceed?*
- Yes
- No
Click “Yes” if you wish to proceed.

Are you a new patient to our practice?*
- Yes
- No

We are committed to protecting your privacy and know it is important for you to understand how your information is handled.
In submitting the information contained in this form, you:*
Acknowledge that your health practitioner and Petersham Family Medical Centre will collect such information (including any personal or sensitive information), for the purposes of providing you with health services or enabling any related communications; and
Consent*
Consent to Petersham Family Medical Centre’s Terms & Conditions, and to Petersham Family Medical Centre handling your personal and sensitive information in accordance with its Privacy Policy.*

To complete this form you may need:
- Medicare card
- Pension/Healthcare/Concession card
Please make sure you have any relevant items ready before you begin.

To protect your personal information this form will clear and reset after 4 minutes of inactivity.

All fields marked with an asterisk (*) are required.

Personal Details
Title
First name*
Last name*
Preferred name
Gender*
- Female
- Male
Date of birth*

DD
MM
YYYY
Occupation
Street address*
Street address line 2
Suburb*
State*
Postcode*
Email address*
Home phone

Health Initiatives
In order to assist us with health initiatives and tailor care
Do you identify as Aboriginal or Torres Strait Islander?*
- Yes
- No
Please select what you identify as*
- Aboriginal
- Torres Strait Islander
- Aboriginal/Torres Strait Islander
What is your country of birth
Medical Information
Medicare card
Do you have a medicare card?*
- Yes
- No
Medicare card - Number*
Medicare card – Position on card*
Medicare card – Expiry date*

DD
MM
YYYY
DVA card
Do you have a DVA card?
- Yes
- No
DVA Card - Type*
- Gold
- White
DVA Card – Expiry date*

DD
MM
YYYY
Pension/Health Care Card
Do you have a Pension/Health Care card?
- Yes
- No
Pension/Health Care Card – Number*
Pension/Health Care Card – Ref*
Pension/Health Care Card – Expiry date*

DD
MM
YYYY

Emergency Contact Information
We collect this information in case of an emergency
Next of kin
Next of kin – First name*
Next of kin – Last name*
Next of kin – Relationship*
Next of kin – Contact number*
Emergency contact
Same as Next of kin
- Same as Next of kin
Emergency contact – First name*
Emergency contact – Last name*
Emergency contact – Relationship*
Emergency contact – Contact number*

Your Health History
Do you have any allergies or are you sensitive to drugs or dressings*
- Yes
- No
Please list*

Social Activities
Do you smoke?*
- No
- Yes
- Ex Smoker
How frequently do you smoke? (eg 2 cigarettes daily/weekly)*
If you’re an ex smoker, can you please provide the approximate date that you ceased smoking?*

DD
MM
YYYY
Do you drink alcohol?*
- No
- Yes
How often do you have a drink containing alcohol?*
How many standard drinks containing alcohol do you have on a typical day?*
How often do you have six or more drinks in one occasion?*
Are you concerned about drinking?*
- Yes
- No

Verification required to use this service
To use this service, we need to confirm you are a genuine person by sending you a verification code. Please enter your mobile phone number and click the “VERIFY” tab below to receive a 6 digit code sent to your mobile number, and then enter the code when prompted to -
Verified Phone Number*

Regarding Pathology/Radiology Investigations

For GP consultations, if your doctor refers you to a pathology and/or radiology service provider for blood tests and/or X-rays, CT or other scans, you will need to make a follow-up appointment for your doctor to evaluate and discuss the results/reports with you.

Also, please note that, because our doctors consult patients nationwide, some pathology or radiology service providers may not yet be linked to our practice management software to allow for automatic download of their test/scan results to our system. You will therefore need to personally follow up and ask your chosen pathology or radiology service provider to send any results of tests/scans etc to the requesting doctor at our practice, via the following:

FAX: 02 9568 4678
or
EMAIL: info@pfmc.net.au
Do you wish to proceed?
- Yes
- No
Click “Yes” if you wish to proceed.

Preferred Pharmacy
In the event that a doctor prescribes a prescription to a patient, that prescription will be sent by the doctor electronically either to the patient as an ePrescription or a registered Australian pharmacy of the patient’s choice, or if the patient does not specify a pharmacy, it will be sent to an Australian accredited pharmacy situated in an area close to the patient’s home. The pharmacy will then dispense the medication.
Pharmacy name
Pharmacy address
Pharmacy contact phone
Pharmacy contact email

Source
How Did You Hear About Us?
Please specify
Communication
I consent to receive SMS reminders, messages and emails*
- Yes
- No

Privacy and Terms
Please sign (using your finger or computer mouse) or place your electronic signature in the box below to confirm that you have read and agree to our “Terms & Conditions” and “Privacy Policy” and that all the information you have provided us in this form is true and correct to the best of your knowledge and belief.
Signature*

Bulk Billing Criteria for GP Services

Bulk Billing Doctors’ Availability :

The following doctors bulk bill, but only during their bulk billing work hours shown below.

Dr Hsien Lim – (Mon – Fri: 9am-4pm)
(Available for both Face-to-Face & Phone consults)

Dr Jeremy Stephenson – (Mon-Fri: 12noon-4pm)
(Available for Phone consults only)

Dr Charmi Vithanarachchi – (Tue: 2pm-9pm)
(Available for Phone consults only)

The eligibility requirements for bulk billing for Telehealth/Phone consults are not the same as they are for Face-to-Face consults, as set out below–

For Telehealth/Phone consults:

You are eligible for a bulk billed Telehealth/Phone consult with one of the above doctors provided: 1) you have a valid Medicare card, and 2) one or more of the following circumstances apply to you–

You require a Telehealth/Phone consult (not longer than 10 mins) AND you have visited Petersham Family Medical Centre in person for at least one face-to-face service from any health professional at the practice in the previous 12 months. (If you are unsure, please call (02) 95608207 or email the practice and we will confirm this attendance).
You need a consult to access mental health services.
You are homeless because you are going through an extreme form of poverty due to the inadequacy of income, health care supports and social supports.
The service is for a child under the age of 12 months.
You are a patient of a medical practitioner at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.
You need a consult relating to blood borne viruses, sexual or reproductive health.
People isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.
People affected by natural disaster, defined as living in a local government area declared a natural disaster by a State or Territory government.

For Face-to-Face consults:

For face-to-face consults, the following categories of patients are bulk billed –

DVA Gold Card holders
Children under 16 years of age
Eligible Health assessments, such as a 40-49 year old health check (one only), seniors check (for patients aged 75 plus – allowed annually), or for a Domiciliary Medication Management Review (for patients on 5 or more medications).
Care plans (subject to eligibility)
All follow up consultations for results or review

Bulk Billed & WorkCover Consultations

Click on this link – Bulk Billing Criteria for GP Services to check your eligibility before requesting a bulk billed appointment by email. If you are eligible and you DO wish to request a bulk billed appointment by email, please click on the link below –

Request a Bulk Billed Appointment

Click on this link – Eligibility Criteria for WorkCover Consults to check your eligibility before requesting a WorkCover consultation by email. If you are eligible and you DO wish to request a WorkCover consultation by email, please click on the link below.

Request a WorkCover Consult

Eligibility Criteria for Workcover Consults

If you wish to request a WorkCover consultation by email, you will need to provide us with ALL of the following information:

Employer details –

Company or Business Name
Phone
Email

Insurer details –

Company Name
Claim number
Case manager’s full name
Phone
Email
A copy of any relevant evidence of any correspondence (notices, emails, letters, etc) between you and your insurer that clearly shows that your claim is covered by your insurer and is valid for future consults with our doctors.

IMPORTANT

If you cannot provide us with the details listed above, and attach evidence of your eligibility, we unfortunately are not able to give you an appointment for a WorkCover consult with one of our WorkCover doctors unless you pre-pay for the consult.

Request for a Bulk Billed Appointment

Step 1 of 19

Need a Bulk Billed Appointment ?

Bulk Billing Doctors’ Availability

Which service do you require today?

Which service do you require today ?

The following services cannot be bulk billed, for any patient.

Please tick the reason below for your eligibility for a bulk billing appointment (You must also have a valid Medicare card).

For Telehealth/Phone consults:

For face-to-face consults:

If we have asked for relevant information or evidence to support your eligibility, please enter/upload it below:*

IMPORTANT

Regarding Cancellation/Non Attendance

Regarding doctor’s availability -

Personal Details

Health Initiatives

Medical Information

Medicare card

DVA card

Pension/Health Care Card

Emergency Contact Information

Next of kin

Emergency contact

Your Health History

Social Activities

Verification required to use this service

Regarding Pathology/Radiology Investigations

Preferred Pharmacy

Source

Communication

Privacy and Terms