Book an Appointment

To book an appointment to see one of our Ophthalmologists, please complete the online form below. One of our friendly Receptionists will be in touch shortly to arrange your appointment.

For urgent enquiries please call us on 07 3239 5000.

Personal Information
First Name*
Last Name*
Date of birth*
DD slash MM slash YYYY
Details about your condition*
Referral Information
Do you have a current referral from your GP or Optometrist?*
- Yes
- No
GP, Ophthalmologist or Optometrist Name
Practice Name
Referrer's Phone Number
Which QEI Specialist are you being referred to?
File
Max. file size: 512 MB.
Have you been treated at the QEI Clinic before?
- Yes
- No
Specific appointment request information
Contact Information
Home phone
Mobile
Email address*
How would you prefer to be contacted?
- Email
- Phone

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