The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

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Required format:

GiAjvnXEBKhSGATKXrhLC63qrQYKLddR7b5LRn4zaX6Dt9FFgEyZEy576vzSWrXnsnXMAqjqNrjGeZ72XNn6dytrVauToQM3gvb6ipgubusKLDnkbs5Um7

Adult Specialist Clinic (Outpatients) Enquiry Form

This Adult Specialist Clinic (Outpatients) enquiry form is to:

Request to CHANGE an appointment.
Request to CANCEL an appointment.
Request to be REMOVED from a waitlist.
Request to UPDATE your contact details.

We will aim to respond to your enquiry within 48 hours. If your enquiry is urgent or related to an appointment within 48 hours, please call us directly on 03 8345 6490.

For other enquires not related to Adult Specialist Clinics, please contact the relevant area directly.

I would like to:

* must provide value

Change my appointment (unable to attend, need to reschedule)

Cancel my appointment (service no longer required)

Be removed from waitlist (service no longer required)

Update my contact details

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I understand that if I change my appointment, I will be given the next available appointment. If there are no appointments available, I will be put back on the waitlist

* must provide value

Yes, I understand

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Please tell us why you need to change your appointment?

* must provide value

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I understand that if I cancel my appointment, I will be discharged from the service and will need to see my GP to get a new referral to book another clinic appointment.

* must provide value

Yes, I understand

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Please tell us why you are cancelling your appointment

* must provide value

Appointment no longer required / condition has resolved

Seen elsewhere

Other:

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If 'other', please specify:

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I understand that if I am removed from the waitlist, I will be discharged from the service and will need to see my GP to get a new referral.

* must provide value

Yes, I understand

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Please tell us why you are wanting to be removed from the waitlist:

* must provide value

Appointment no longer required / condition has resolved

Have been seen elsewhere

Other:

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Other:

* must provide value

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Which outpatient wait list are you wanting to be removed from?

* must provide value

If other, please specify:

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