Podiatry Request Form

Please complete the following details in order that Healthcare 2 You can provide podiatry treatment for your resident/loved one. Please note, this is NOT a referral form.

  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • Billing Details

  • MM slash DD slash YYYY

NB: If you are a DVA Gold Card holder, a referral from the doctor needs to be obtained before your consultation.

Eligible patients can receive up to 5 treatments at no cost with a referral from a doctor. Please ask the podiatrist how you can organise this or contact our office online or via phone at 1300 882 374.