Request a virtual care appointment for registered residents

The below form is for registered facilities to submitting virtual care appointment requests exclusively for residents who are already registered with Aged Care GP (ACGP).

During business hours, from 9 AM to 4 PM Monday to Friday, a nurse will triage your request and arrange a virtual care consultation with a doctor. If the request is submitted outside these hours, it will be reviewed and handled on the next business day.

Please complete all required information below.

If this is a medical emergency DO NOT use this form, contact 000 immediately.

Name of Person Responsible for this issue *
Phone number of person responsible for this issue *
Your Role: *
Priority *
Facility Name: *
Resident First Name: *
Resident Last Name: *
Resident's Date of Birth: *
Regular GP Name for the Resident: *
Phone number to call you directly to book a telehealth: *
Your Email: *
Explain the current problem the Resident has including obs/oxygen levels/BP etc done: *Lack of information will delay your virtual care booking. *
Relevant history to the situation: *Lack of information will delay your virtual care booking. *
What type of medication charts do you use?: *