Partner for Health

Online Triage Form:

(Press and hold Shift key to dictate speech to text in any free text box)

▼ 1. Message to Patient

Search for a commonly used template:

Message to patient:

▼ 2. Test Request

Please select the tests to request:

▼ 3. Appointment Needed

Suggested Clinician:

Consultation Type:

Timeframe:

Any information you would like to relay to the reviewing clinician

▼ 4. Actions/Info for the Care Coordinator

Care Coordinator to send the message to patient
Care Coordinator to request the selected test requests
Care Coordinator to book the requested appointment
Other:
Care Coordinator to also provide the following safety netting when booking the appointment: