MML | Request Appointment

1 Request a Specialist

2 Solicitor Detail

3 Patient Case Detail

Please complete the form below to request an appointment with your choice of Doctor or Specialist field. You can search for a Doctor using our Specialists Directory. Please click here to search for a Specialist.
Requested Doctor
Please use our Specialists Directory to help locate a Doctor
or
Doctor Specialty
Please enter the specialty of the required Doctor e.g. Radiology

Please enter your details for this section.
Solicitor/Firm*
Name*
First Last
Contact Phone*
Contact Fax
Contact Email*
Administrative Information
Your Reference/File No.*
Case Type*
Case Urgency
Other (Please Specific)
Interpreter required*
Interpreter booked by MML*
Additional Information

Please enter your clients/Patients details.
Name*
First Middle Last
Address*
Street Address Suburb State Postcode
Phone*
Mobile
Email
Date of Birth*
Gender
Injury/Incident Details
Injury/Incident Date*
Insurance Company
Claim Number
Regions to be scanned
(for radiology appointments only)
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