Availability Form

Your employer or prospective employer has requested that you attend a medical assessment and has engaged MAX Health to organise this assessment for you.

MAX Health organises a range of medical assessments including pre-employment medical assessments, review medical assessments, health monitoring/surveillance assessments, health and wellbeing assessments, executive medical assessments, vaccinations, audiometry, spirometry and drug & alcohol tests.

To help us organise a suitable time and place for your assessment, please provide us with some information about you and when you are available to attend an assessment.

Once we have obtained your availability and preferred location, we will book your appointment(s) and send you confirmation of your appointment(s) information.

Participant Availability

Legal First Name *

Surname *

Email Address *

Date of Birth *

Mobile *

ZW Reference Number *

Alternate Phone Number

Participant Email *

Employer/Prospective Employer

Job Title *

Do you have any disability or accessibility requirements to attend a medical appointment?

YesNo

If Yes, please provide further information

Availability

Please provide us with some information about when you are available to attend an assessment and where you would prefer to go for your assessment. MAX Health will endeavour to book your assessment based the days and times you have provided, within a reasonable distance of your preferred location.

We recommend that you provide as many days, times and locations as you can so that we can organise a suitable assessment for you. Ideally we request at least nine hours over a minimum of three business days.

Preferred Appointment Suburb *

Preferred Location Postcode *

Preferred Location State *

Preferred Appointment Suburb *

Preferred Location Postcode *

Preferred Location State *

Day 1 *

Time available from: *

Time available to: *

Day 2 *

Time available from *

Time available to *

Day 3 *

Time available from *

Time available to *

Please note: If you cancel, reschedule or do not attend your appointment your employer or prospective employer may incur a fee.

If you have any questions regarding your medical assessment please refer to our Medical Assessments Frequently Asked Questions - Injurynet or alternatively, if would like to discuss your medical appointment(s) with us over the phone, please call MAX Health on 1300 307 418 during business hours or email ppm@injurynet.com.au

Your Privacy

Your privacy is important to us. Our Privacy Statement is available at www.injurynet.com.au/privacy and provides details about how we manage, collect, hold, use and disclose personal information. It also provides information about how you can request to access, update or correct your information or make a complaint if you have any privacy concerns.

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