Request an Appointment
To make an appointment to see Dr Bopp, please call our rooms on 07 5539 2797.
Alternatively, please complete the form below and one of our team will call you to confirm a day and time.

For Dr Bopp to be able to see you, we do require a referral form from your doctor.
If you already have your referral, please phone our rooms on 5539 2797 to make your appointment or complete the relevant sections of our appointment form below.
If you do not have a completed referral request, you can print one off here and take to your GP.

Please ensure that you bring all relevant medical documentation and your referral request form to your appointment.

Reqeust an appointment

If you have been to see Dr Bopp before, please complete the top section of the appointment form only.
If you have not been to see Dr Bopp before, please complete all sections.




First Name: Who is your referring GP?
Surname: Do you have a referral?
Date of Birth: Reason for seeing Dr Bopp:
Email Address: Have you seen Dr Bopp before?
Address:
Suburb:
Please verify:Please verify
Home Phone: Work Phone:
Mobile Phone: Your partner/Next of Kin:
Relationship: Contact Number:
Medicare Card Number: Reference Number / Expiry:
Health Fund Name: Member Number:
Level of Cover: Veteran's Affairs Number:
Date of last pap smear: Have you had any abnormal pap smears?
Have you had any recent blood tests? If yes, what date & with who?
Have you had any recent ultrasounds, x-rays or CTs? If yes, what date & with who?
Do you have any medical conditions: Please list any previous surgical procedures:
Please list any previous pregnancies: Are there any family conditions:
Do you have any allergies?
If yes, please list:
Please list any medications you are taking:
DISCLAIMER:
Dr Bopp requires your information for the primary purpose of providing quality health care. We require you to provide us with your personal details and a full medical history, so that we may properly assess, diagnose, treat and be proactive in your health care needs. By signing this form and submitting this information to Dr Bopp, I authorise Dr Bopp to use my information in accordance with the Health Privacy Act and to disclose my health information to my referring GP, specialists and medical testing institutions who require my medical history to treat the particular condition/s. I have read and understood the reasons why my information must be collected and I am aware of Dr Bopp's privacy policy on handling patient information. I consent to examination and understand that this appointment may involve pelvic, vaginal examination and/or trans-vaginal ultrasound.