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Glen Waverley: (03) 9566 2733
Pascoe Vale: (03) 8583 0979

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Patient Booking Form

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  • To make a booking, a valid Doctor’s referral is required.
  • Please send the referral via fax (03) 82560142 or email: manager@melbournepaingroup.com.au and proceed with completing this booking.
  • Please see your Doctor to obtain a valid referral before a booking can be made.

    You may still proceed with this online booking; however, no appointment can be made until a referral is received.

  • Patient Details

  • Telephone

  • Emergency Information

  • GP Details

  • Entitlements

  • Claim Details

  • General Health Information

  • Medication Profile

  • eg: Name - Paracetamol, Dose - 1 pil, Frequency - Every 6 hours
    NameDoseFrequency 
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  • Disclaimer

    I understand the details of my medical condition(s) may be revealed for the purposes of optimising my treatment and of continuity of care. I believe the details provided to be true and correct, and hereby give permission for these to be disclosed to other medical practitioners in relation to my medical condition(s).
  • Do you consent to Melbourne Pain Group contacting you via SMS or Email? eg. SMS appointment reminder or emailing forms
  • Our rooms will contact you to make an appointment
  • Please see your Doctor to obtain a referral.

    You can send the referral via fax (03) 82560142 or email: manager@melbournepaingroup.com.au

    Once the referral is received, our rooms will contact you to make an appointment.

Contact Us

Glen Waverley:
Phone: (03) 9566 2733
Fax: (03) 8256 0142
Pascoe Vale:
Phone: (03) 8583 0979
Fax: (03) 9011 9658
Email: manager@melbournepaingroup.com.au

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Our main Consulting Suites

Victorian Rehabilitation Centre

499 Springvale Road,
Glen Waverley VIC 3150

We are located at the road-side front entrance of the centre. There is parking available at this entrance, or parallel on the Springvale Road service street in front of the centre.

Dorset Specialist Centre

167 Derby Street,
Pascoe Vale VIC 3044
Click here for more location information.
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