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Get help for any health problem

Appointment Request

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About the problem

Please describe your symptoms, what’s changed (if ongoing), any concerns, and what help you’re hoping for
For example, 3 days, 2 weeks, several months
How would you prefer us to contact you? *

Support needs

Do you need a chaperone present during your appointment?
Do you need a translator? *

Communication preferences

Can we send your appointment details by text message?

Upload a photo (optional)

If a photo would help explain your concern, please upload one:
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