Make an Appointment 2011

Request an Appointment at Carlton

This form is for Pensioner and Health Care Card Holders wanting an appointment at Carlton only. All other patients should contact their local ACO clinic to make an appointment.

All fields marked * must be completed

Have you attended the ACO clinic previously*

Yes
No
Unsure

First Name*

Surname*

Address*

Suburb*

Post Code*

Telephone No*

Email Address*

I am a permanent resident of Victoria*

Yes
No

I hold a

Medicare
Department of Veterian Affairs (Gold Card only)

Card number*

I hold a

Pensioner Concession Card
Health Care Card

Card number*

Last eye examination

My last eye examination*

How long ago

Years* Months*

I require an interpreter*

Yes
No

Language

Please note due to a limited availability of interpreters, there are longer waiting times for appointments requiring an interpreter.

Thank you for requesting an appointment at the ACO Carlton Clinic. You will be sent your appointment details via mail.

Please note if you have been seen by another optometrist or an ophthalmologist in the past two years, you are required to bring a referral letter on the day of your appointment.

If you have any queries, please contact the clinic on 9349 7400.