Let's Check Your Eligibility
We need to ask a few quick questions to make sure our service is right for you. This should take about 2 minutes.
Are you 18 years or older and an Australian resident?
We can only provide services to adults residing in Australia.
Have you been diagnosed by a medical professional?
A prior diagnosis from a medical health professional is required to proceed.
What is your primary condition?
Select all that apply.
How long have you had this condition?
We need to understand the duration of your condition.
Do any of the following apply to you?
Please select all that apply. This is for your safety.
Do you currently have a substance use disorder or are you on opioid substitution therapy?
Are you currently pregnant, breastfeeding, or planning to become pregnant?
Great News!
Based on your responses, you may be eligible for an alternative healthcare consultation. Let's continue with some personal and medical information so our practitioners can provide you with the best care.
Providing detailed and accurate information allows our healthcare team to provide the safest and most effective care possible.
Personal Information
What is your first name?
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What is your surname?
Press Enter to continue
What is your email address?
We'll send your booking confirmation here.
Please confirm your email address
Re-enter your email to make sure it's correct.
What is your phone number?
Your practitioner will call you on this number for your consultation.
What is your date of birth?
You must be 18 years or older.
What is your gender?
What is your height?
What is your weight?
What is your postal address?
Medical History
What type of medical identification do you have?
Have you previously been prescribed alternative medication?
What are your reasons for seeking assistance?
Select all that apply.
Family Medical Conditions
List any known medical conditions in your immediate family.
Current Medications
List all medications, supplements, and vitamins you are currently taking.
Allergies & Sensitivities
List any known allergies or sensitivities, or type "none".
How many standard alcoholic drinks do you consume per week?
How many cigarettes do you smoke per day?
Primary Care Provider
Who is your primary care provider?
Your GP or regular practitioner / clinic name.
Practitioner Contact Details
If known, provide their email and phone number so we can request your medical information.
How did you hear about HerbaCure?
Acknowledgements
Please review and acknowledge the following
All acknowledgements are required to proceed.
Choose Your Appointment
Select a date and time that works best for you. Your practitioner will call you at your scheduled time.
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Review Your Information
Please check everything looks correct before submitting.
Personal Information
Medical History
Primary Care Provider
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