ACT Government Medical Booking Form

"*" indicates required fields

Standard Pre-employment Medical

Applicant Details

Name*
DD slash MM slash YYYY
Please select from the drop-down menu
Please ensure to select the directorate from the drop-down list

Appointment Details

MM slash DD slash YYYY
MM slash DD slash YYYY
Preferred appointment times*
Please upload any previous medical records, medical management plans, or any other relevant documentation.
Max. file size: 200 MB.