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Pharmacy: Footes Pharmacy Grange Road

Address: 82 Grange Road
Eastern Heights, QLD, 4305

Phone: 0732816066

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Diabetes check

Duration: 30 min

Diabetes check

Flu Vaccination Service

Duration: 10 min

Flu Vaccination Service

Hormonal Contraception Consultation

Duration: 20 min

Hormonal Contraception Consultation

Insomnia Consult (CBTi)

Cognitive Behavioural Therapy for Insomnia

Duration: 60 min

Insomnia Consult (CBTi)

Leave of Absence Certificates

Duration: 10 min

Leave of Absence Certificates

Non-vaccination injection

Duration: 10 min

Non-vaccination injection

Pharmacist Consultation

You can request for a Pharmacist Consultation at our pharmacy. Book for a consultation with one of our pharmacists.

Duration: 60 min

Pharmacist Consultation

Sleep Apnoea Consult Please call for availability

Sleep Apnoea Consultation

Duration: 30 min

Sleep Apnoea Consult Please call for availability

Whooping Cough Vaccine

Duration: 10 min

Whooping Cough Vaccine

Pre-Screening Form

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First Name*

Last Name*

Mobile*

Email*

Gender*

Dose

Medicare Number

IRN

Medicare Expiry

Name on card

Enter your Medicare number and other details to reduce your waiting time in the pharmacy.

Date of birth*

Street*

Suburb*

State*

Postcode*

Reason for consultation*

What are you experiencing with your health? Provide information to help with the consultation.

Relevant background information*

Include information relevant to your situation e.g. medication you are on, recent health issues, allergies etc.

I am consenting as a substitute decision-maker (e.g. carer) on behalf of the patient

Name of substitute decision-maker*

Consent to pilot clinical service and costs*

If applicable, I agree to participate in the Queensland Community Pharmacy Chronic Conditions Management Pilot and understand the scope of the clinical service. I consent to paying the pilot consultation fee and any costs associated with the service. I understand that if I decide not to proceed with receiving some part of a service, I may still be required to pay for services that have already been provided. I understand that my pharmacist will inform me if this is applicable to my situation.

Consent to pilot evaluation*

If applicable, I consent to participating in the evaluation of the Queensland Community Pharmacy Chronic Conditions Management Pilot and agree to being contacted to participate in surveys about the pilot. I consent to my administrative health service data being analysed for evaluation purposes. I understand that my pharmacist will inform me if this is applicable to my situation.

Organisation Code*

Division*

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Participant ID*

Service selection*

I have read and accept the Guild Corporate Health Privacy Policy. I give consent for the pharmacy to provide my personal information to my employer for reconciliation and program management purposes. *

I have read and accept the MedAdvisor Terms and Conditions and Privacy Policy. *

This program closes at 4pm AEST July 31st. Do not book a vaccination after this date/time.

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