Make a Booking

Please complete the form below to request an appointment at the Geelong Breast Clinic.
Alternatively you can call our bookings line on (03) 5222 0900.

When we receive your appointment request online, we’ll call you to confirm the date and time of your appointment. We will also check your personal details and answer any questions you may have.

PLEASE NOTE FOR ALL BREASTSCREEN APPOINTMENTS, please visit breastscreen.org.au or call 13 20 50

*First Name

*Last Name

*Date of Birth

*Phone Number

Medicare Number

Concession Card Number

Email Address

Referring Doctor

*Examination Required

Ultrasound - Breast

For Ultrasound - Breast

Preferred Location

For Diagnostic Mammography

Preferred Location

For MRI - Breast

Biopsy/FNA - Breast

For Biopsy/FNA - Breast

If Other

If not included in Examination List, please specify the examination required.

Preferred Date

Preferred Time

Morning

Afternoon

No Preference

Please note we will try and accommodate your request best we can, however some examinations are only performed a certain times or days.

Comments

Referral Upload

On a mobile device? It is as simple as taking a picture and uploading. You can also upload a scanned copy of your referral.

*Security Check

Enter the text in the image above.