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Request An Appointment


Contact Information

First Name *
Last Name *
Date of Birth / /   *
Contact Email *
Mobile Number / Phone Number *
Other Contact Number
 

Appointment Details

Type of Appointment
For a
Preferred Doctor
 
Dr Kass' Working Hours:

Monday
11:00am
-
07:00pm
Tuesday
10:00am
-
04:30pm
Wednesday
11:30am
-
3:00pm
Thursday
12:00am
-
07:00pm
Friday
11:00am
-
05:00pm
Saturday
09:30am
-
12:30pm
Sunday
closed
 
 
Public Holiday
closed
 
 
 
Preference 1 / /   :

Preference 2 / /   :
Do you, a friend or relative require wheelchair access?  
 

Trip Information

Number of people attending*

Does this include children under 12 year old?  
Where will you be travelling to? Please include all destinations
Depature (or Approximate) / /
Duration of Travel
 

Other Information

Please let us know any other relevant information regarding our appointment request:
 

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