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Prime Central Bookings Request Form

To enable Prime to facilitate a medical booking into a Prime Alliance Clinic, please complete the form below
 

Prospective Employee's Details
























(if none, please tick box below)

Billing Information




Specific location where appointment is to be made
















Results (Please specify preferred method of receipt and provide details)




Appointment Details

Please note the approximate results turnaround times: 

WA Metro 24 hours
Regional-WA & Interstate 3-5 days
Remote-WA & Interstate 5-7 days
Interstate Metro 3-5 days


(Please Provide a range of dates and times the candidate is available)

      

 
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