Request an appointment Request an Appointment Please use this form to request a specific appointment. This form is not to request a general appointment with your doctor. Name First Last Date of Birth DD slash MM slash YYYY Address Street Address Address Line 2 City County / State / Region ZIP / Postal Code Mobile NumberAppointment TypePlease select the appointment type(s) you wish to book. Asthma Review B12 Blood Pressure Check Blood Test – GP has requested Blood Test – Hospital provided form Child Immunisations Contraception Review COPD Ear Check Ear Irrigation Injection INR Removal of sutures Smear Test Travel appointment Injection Type OptionalIf selected injection please specify which injection.