ACT Government Medical Booking Form - Aspen Corporate Health

Applicant Details

Name*

First Last

Phone number*

Date of birth*

Email*

Preferred Clinic Location*

Please select from the drop-down menu

Directorate*

Please ensure to select the directorate from the drop-down list

Position title*

Please upload your Job Description (JD) in either pdf or word document (NOT the Letter of Offer with salary). If you do not have a JD, please ensure to request one from your recruiter. Without JD, your booking will not be proceeded.

Accepted file types: pdf, docx, docmx, docb, dotm, doc, Max. file size: 2 MB.

Recruiter Email*

AGS Number (if known)

Invoice to be sent to (email address) - For Aspen Medical*

Medical Components Required*
Standard Pre-employment Medical
Audiometry
Spirometry
Instant Drug and Breath Alcohol
Functional Assessment
ECG
Rail Medical (Category 2)
Rail Medical (Category 3)
Baseline Asbestos Examination
Chest X-ray (ILO) (to be confirmed by assessing Dr) - Only for Asbestos

Appointment Details

1st Suitable Date*
DD slash MM slash YYYY

1st Suitable Time*

Hours

:

Minutes

AM/PM

2nd Suitable Date*
DD slash MM slash YYYY

2nd Suitable Time*

Hours

:

Minutes

AM/PM

3rd Suitable Date*
DD slash MM slash YYYY

3rd Suitable Time*

Hours

:

Minutes

AM/PM

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Available dates from:*
MM slash DD slash YYYY

This field is hidden when viewing the form

Available dates to:*
MM slash DD slash YYYY

This field is hidden when viewing the form

Preferred appointment times*
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM

Please specify any special requirements

Upload files
Please upload any previous medical records, medical management plans, or any other relevant documentation.
Max. file size: 2 MB.

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