Book A Colonoscopy Online

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Complete this online form to book a “No-Gap” colonoscopy in the public hospital (if you have a medicare card), or in a private hospital (if you have private health insurance or DVA).

Reason for requesting a colonoscopy*

Select your type of Health Cover*

Are you otherwise healthy with no recent hospital admission with breathing or heart conditions, and are not taking blood thinners (eg, warfarin, clexane or dabigatran) ? *

If you have a health condition that concerns you please describe below.

 yes no

Title *

First Name*

Surname*

Gender*

DOB *

Address*

Contact Phone Number*

Email Address*

Medicare Number

Medicare Family Reference Number

Health Fund

Health Fund Membership Number (if applicable)

Preferred Private Hospital for Colonoscopy (if have private health insurance or DVA)

Preferred Public Hospital for Colonoscopy (if have medicare only)

Preferred Surgeon

If Gastroscopy is also required select your reason

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Informed Consent

During colonoscopy a flexible colonoscope is inserted via the anus into the bowel to examine the entire colon for polyps, cancer, infection and inflammation. This is a painless procedure with sedation provided by an anaesthetist. You need to drink a bowel preparation and have only clear fluids 24 hours before (no solid food). Colonoscopy is extremely safe, however all procedures have some risk. Perforation of the colon is a complication where a hole is made in the bowel. It is rare and occurs in less than 0.2% of cases. If perforation occurs, it may require abdominal surgery to repair the bowel wall. Care will be taken to avoid this complication. Bleeding can occur after removal of a polyp if you are on blood thinners. Anaesthetic risks are very small and will be discussed with you by your anaesthetist the day of your procedure. If you are also having a gastroscopy, this is a quick and safe procedure, with very little risk. There is a small risk of aspiration or wheeze (bronchospasm), which is reduced by fasting (no liquids) the full 6 hours prior to your procedure.

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Have you read the above “Informed Consent” for colonoscopy and agree to go ahead with colonoscopy? *

 yes no

Referring GP's Name *

Referring GP's Phone Number *

Have you answered 'yes' to all of the above questions qualifying you to have a colonoscopy booked online?*

 yes no

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select here for a Video Description of Colonoscopy

select here for a Detailed Description of Colonoscopy and Bowel Prep Instructions.

select here for a Direct Access Colonoscopy Questionnaire