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Complete this form to get a referral for STI testing.
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Get an STI test today.
Complete this form to get an STI test today.
If you already have a user login, you can
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Name
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First
Last
First and Last name, as per Medicare card or Passport!
Email
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Password
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Date Of Birth
*
Day
Month
Year
Please enter to continue.
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Age
You must be over 16 to use PrEP Health to obtain PrEP.
Australian Mobile Phone Number
*
We need to reach you by SMS when results are ready. 10 digits. NO +61
Address
For compliance we need your address to prescribe you.
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Street Address
*
We just need postal address. Nothing is sent to your house unless ordered.
Street address 2
Suburb
*
State
*
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Post Code
*
Gender/Sex as per Medicare
*
Male
Female
Transgender
Other
Unknown
Gender with Medicare, if not updated, needs to match so that eScripts and Medicare reconciliation works. We are inclusive and this service is for everyone. However, the nature of the medical referral process requires us to adhere to certain healthcare language guidelines that may not suit you. We hope you understand. We are doing our best and we want you to feel welcome here.
Gender/Sex
*
Male
Female
Transgender
Cis male
Cis female
Indeterminate/intersex/unspecified
X
Trans-male
Trans-female
Other
Unknown
How do you identify?
Consultation
Do you have Medicare?
*
Medicare
No Medicare
Individual Healthcare Identifier (IHI) number
This number facilitates eScripts should you need treatment.
Individual Healthcare Identifier (IHI) number
*
Yes I have an IHI number
No, I will apply for an IHI number.
You will need an IHI number to receive your prescription. If you don't have one yet, we will send you information on how to get it afterwards.
Individual Healthcare Identifier (IHI) number
*
After you complete the form, please follow the links for getting an IHI number to facilitate an eScript. https://prep.health/no-medicare
Consultation options.
PrEP Health offers the option for consultations with telephone appointments. The telephone appointments can be bulk-billed (if you have medicare) or claimed with insurance (OSHC for example).
Medicare Appointment Option
*
Telephone appointment (Bulk-billed/FREE)
No appointment ($41.99)
You can choose between having an appointment before each prescription, or you can pay for the doctor to review your results, prescribe your PrEP.
No Medicare Appointment Option
*
Telephone appointment ($85.00)
No appointment ($41.99)
You can choose between having an appointment before each prescription, or you can pay for the doctor to review your results, prescribe your PrEP.
Questionaire.
These questions are essential for testing.
Do you have sex with other males and/or transgender people?
*
Yes
No
We are inclusive and this service is for everyone. However, the nature of the medical referral process requires us to adhere to certain healthcare language guidelines that may not suit you. We hope you understand. We are doing our best and we want you to feel welcome here.
Do you identify as Aboriginal and/or Torres Strait Islander?
*
Yes
No
Unknown
If you are of First Nations, you may be able to access PrEP under the "Closing the Gap" program. This response may also indicate for additional testing.
Are you, or have you ever been a sex worker?
*
Yes
No
This response may indicate risk for additional testing.
Do you or have you previously injected drugs?
*
Yes
No
This determines if you need HEP C screening on your pathology referral.
Have you ever been diagnosed with syphilis?
*
Yes
No
This doesn't impact on being prescribed PrEP.
When were you diagnosed with syphilis?
*
Day
Month
Year
This question must be answered
Medicare details
We need your valid Medicare Card to facilitate the service.
Medicare Card Number
*
10 numerical digits
Medicare Card Reference Number
*
Number infront of your name on your card
Select a doctor
This doctor will be on your referral to receive the results. All of our PrEP Health doctors are amongst the best sexual health General Practitioners in Australia.
Please select a doctor with a schedule that suits you best.
Please select doctor for referral.
*
Dr Benson Riddle (He/Him); Available Monday, Wednesday, Thursday, Friday.
Dr Tom Duo Wang (He/Him); Available Saturday AM
This doctor will be on your pathology referral to receive results. Please select a doctor with the schedule and time that you prefer if you need an appointment.
Confirmation
You will be able to book your annual telephone appointment after this submission.
You do not have an Australian Healthcare concession card or Medicare Card. After you complete the form, please follow the links for getting an IHI number to facilitate an eScript. https://prep.health/no-medicare
You confirm that you have a provided a valid Medicare Card.
Total charged today
$ 0.00
I authorise Prep Health to debit the total charge today amount.
Agreement
*
I accept the Terms and Condtions of the PrEP Health service
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Terms & Conditions
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Please Note: You will receive your receipt and referral in two emails after submitting this form. Please check your junk mail as we are talking about sexual health after all!
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