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*

If Audiometry, Spirometry and/or Functional Assessment is also required on top of the Standard Pre-employment medical, please ensure to confirm with your recruiter beforehand.

Medical Components Required*
Standard Pre-employment Medical
Audiometry
Spirometry
Functional Assessment
Asbestos Exposure Screening - Spirometry included

Functional Assessment Types*

Light Functional Assessment

Moderate Functional Assessment

Heavy Functional Assessment

Appointment Details

1st Suitable Date*

1st Suitable Time*

Hours

:

Minutes

AM/PM

2nd Suitable Date*

2nd Suitable Time*

Hours

:

Minutes

AM/PM

3rd Suitable Date*

3rd Suitable Time*

Hours

:

Minutes

AM/PM

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Available dates from:*

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Available dates to:*

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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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