Justin Roe Acute Knee Clinic

Full Name *

Email Address *

Phone *

Date of Birth *

Age

Date of Injury *

Details of Injury *Please enter a brief description of what happened

Please confirm that this is an urgent injury *

YesNo

This form is for our Acute Knee Injury Clinic only. Please call 02 9409 0558 to make a standard appointment.

Have you recently visited *

An Emergency DepartmentHospital ClinicGPPhysio

Do you have recent imaging? *

YesNo

You can still book into our Acute Knee Injury clinic but will need to get imaging performed. Please call 02 9409 0558 to make an appointment and get instructions from staff.

Do you have the imaging report? *

YesNo

Please attach your imaging report (max 5MB)

Browse

If the file size is over 5MB, please try using this file compression service from Adobe - https://acrobat.adobe.com/link/acrobat/compress-pdf

Date of Imaging *

Practice / Imaging group where imaging was performed *

Location where imaging was performed *

Do you have a GP referral? *

YesNo

Do you have private health insurance? *

YesNo

Please press SUBMIT to confirm you require an appointment for an acute injury with A/Prof Justin Roe.
You will receive an appointment date and time via email or telephone call by the next business day.
Please note that acute knee injury clinics take place on Monday afternoons and Tuesday mornings on alternate weeks.

Provisional appointment datedd/mm

Timehrs/mins

Confirmed appointment datedd/mm

Timehrs/mins