Contact

Alliancern

Alliance Insurance Pathology
ABN 273 1819 5330

Phone: (02)4946 7924
Fax: (02) 4965 9782
Mobile: 0404 511 882

 

 

Mail: PO Box 3259
Valentine
NSW 2280

Online Booking form:

Name
D.O.B (dd/mm/yyyy)
Address
Suburb
State
Post Code
Mobile Phone
Home Phone
Work Phone
Adviser
Adviser Phone
Advisers Email (required)
Insurer #1
App no. 1
Insurer #2
App no. 2
Doctors Name
Doctors Address
HIV: Yesno
HbA1C: YesNo
MBA20 incl HDL/LDL: Yesno
Standard Health Evaluation/Paramedical: Yesno
Hepatitis B / Hepatitis C Yesno
Blood Pressure x 3: Yesno
Full Blood Count: Yesno
Resting ECG: Yesno
PSA: Yesno
Quick Check / Fast Check: Yesno
Serum Cotinine: Yesno
MSU: Yesno
Iron studies incl Ferritin:Yesno
Stress ECG: Yesno
Stress Echocardiogram: Yesno
GP Medical: Yesno
Specialist Medical: Yesno
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