Doctor Appointment Request Form

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Any Hampton Park Secondary College student can use this form to request an appointment with the doctor, who attends the college one day a week.

The doctor - also known as a general practitioner or GP, is from a local clinic: Southern Cross Medical Centre, and will be able to support students with any of their health needs.

GP appointments will be available on Thursdays, during the school term (not over the holidays), and will be 20 minutes per appointment. Appointments will be held in the GP clinic near E Bock, by Fordholm Road.

When your appointment is booked, it will appear on your Compass timetable as 'meeting' and you will receive a confirmation message if requested.

Just like when a young person sees a doctor outside of school, the GP will make the decision about who - if anyone, needs to know about the things that you talk about. If you would like more information about confidentiality and privacy, see here: https://www.education.vic.gov.au/Documents/about/programs/health/Consent%20and%20confidentiailty%20Student%20information%20sheet%20%20Revised%20May%202017.pdf

If you need more information on GPs and what they might be able to help you with, see here for a video:
https://ipx.bcove.me?url=https%3A%2F%2Fwww.healthdirect.gov.au%2Fthe-role-of-a-gp%3FvideoId%3D5803351036001&accountId=1922092292001&experienceId=5b319d6a1edd4e00199b0dc1&videoId=5803351036001

Student First Name *

Student Surname *

Date of Birth *

YYYY

Biological Sex/Gender *

Please list the sex your were born as, so that the clinic can find your details on Medicare

Male

Female

Other

What can the doctor help you with? *

General Appointment: have questions, feeling sick, just not feeling quite right

Mental Health: feeling worried, down, sad, or off

Sexual Health: questions about being safe and healthy

Sleep: struggling to fall asleep, having nightmares

Eating: feeling sick after eating, not eating

Injury: support after being hurt

Chronic Health Management: support for ongoing health issues like asthma or diabetes

Other

Required

Do you require an interpreter?

If so please list the language here.

Medicare number

If you don't know your Medicare number that's ok. If you're not sure what a Medicare number is, check out the instructions below

Australian Medicare card

Would you prefer to see a GP that is a certain gender? *

Male

Female

Either gender - no preference

House *

Hollows (Blue)

Freeman (Red)

Mabo (Green)

Walton (Yellow)

Mentor Group *

Please select your preferred appointment time (if you have one)

Period 2

Period 3

How would you like your appointment confirmed? *

Your appointment will also appear on your Compass timetable as 'meeting.'

Microsoft Teams message

Email to HPSC student email address

Do not want a reminder

If you are making this appointment on a student's behalf, please list your name

Submit

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