General Telehealth Consult
Request an appointment
& consent form.
Complete this intake before your consultation. Your doctor reviews all information prior to your appointment — the more detail you provide, the better prepared they will be.
Personal Information
Your basic registration details for our clinical records.
Contact & Address
How we reach you and your registered address.
Medicare & Identification
Required for safe prescribing and monitored medicine compliance.
10 digits. Required to verify use of monitored medicines via QSCRIPTS. If you do not have a Medicare number, enter 10 zeros.
Driver's licence — identity verification
Please email a photo of your driver's licence (name and date of birth only — no licence number required) to care@apexmetabolichealth.com.au with your full name in the subject line. This is collected for identity verification only and destroyed once confirmed.
Access allows your doctor to view your medical records and current medications to make an informed diagnosis and prescribe appropriate treatment. Access is obtained only during consultation and while you are a current patient. Your file is kept completely confidential throughout.
Reason for Consultation
Tell us what you'd like help with. The more detail you provide, the more prepared your doctor will be.
Your doctor reads this before your consultation — more detail means a more prepared doctor.
Forward previous test results
Email previous blood tests, DEXA scans, or other relevant results to care@apexmetabolichealth.com.au with your full name in the subject line. Your doctor will review them before your consultation.
Physical Health
Baseline physical measurements and your regular GP details.
Allergies & Current Symptoms
Please indicate if you currently suffer from any of the following.
Medications, vitamins, minerals, food, latex, etc.
0 = very poor, 10 = excellent
0 = exhausted, 10 = highly energetic
Medical Conditions
Do you suffer from any of the following? Select all that apply — past or present.
Medical History
Include anything relevant, even if it seems minor. Your doctor reviews all of this before your consultation.
Mark any work-related injuries with an asterisk (*) and note if a workers compensation claim is involved.
Include everything. Over-the-counter items and supplements all count.
Lifestyle
Your daily habits, exercise, nutrition, and relevant lifestyle factors.
Leave blank if not applicable
Leave blank if not applicable
0 = extremely stressed, 10 = completely calm
This helps your doctor understand your broader mental health context.
Goals & Pharmacy
Your health objectives and preferred pharmacy for any prescribed protocols.
If treatment is prescribed, where would you prefer your protocol to be fulfilled?
Choose Your Path
After your consultation, two pathways are available. One is a complete clinical program. The other is a prescription only.
Our team will confirm consultation fees and program details based on your selected pathway. You can change your selection at any time before your consultation.
Declaration & Consents
Please read each statement carefully before submitting.
Agent Agreement
The individual filling out this form consents and agrees to Apex Metabolic Health, its Directors, Staff, Contractors and associated partners to act as their agent. You agree to giving consent for the agent to act on your behalf with AHPRA-registered Doctors, Pharmacists, and Allied Health Professionals within the interest of your enquiries and in accordance with the Australian Privacy Act. You acknowledge that the Apex Metabolic Health team comprises contractors and admin staff who are not Doctors and cannot provide medical advice. You agree for the team to act as an agent in liaising with your Doctor/s, the pharmacies and other parties at your instruction and in your best interests.
Note: Body enhancement or performance enhancement for purely aesthetic or competitive purposes is not a clinical treatment goal and will not be prescribed by a Doctor for this purpose.
Waiver & Disclaimer
By submitting this form, I agree to only use any medication or treatment prescribed to me, if any, in the correct and safe manner as ordered by the Doctor. I agree that the information and any prescribed protocols are only for me and that I will not sell, share or distribute medication or protocols to any other parties. I agree to use any medication at the prescribed dose only and to report any side effects or adverse reactions to the pharmacy and clinical team promptly.
Submission Summary
Your progress is saved automatically. All information is private and confidential. This is not a substitute for emergency medical care.