Facility Request 9am-4pm Mon to Fri

If this is a medical emergency DO NOT use this form, contact 000 immediately.

Examples of emergencies include: chest pain, acute shortness of breath, head injury, persistent distress.

Submit requests only for residents currently registered with ACGP.

Between 9am and 4pm Monday to Friday, a nurse will triage your request and

book a virtual care consult with a doctor.

Outside of these hours, your request will be handled the next business day.

Name of Person Responsible for this issue *
Phone number of person responsible for this issue *
Your Role: *
Priority *
Facility Name: *
Resident First Name: *
Resident Last Name: *
Resident's Date of Birth: *
Regular GP Name for the Resident: *
Phone number to call you directly to book a telehealth: *
Your Email:
Explain the current problem the Resident has including obs/oxygen levels/BP etc done: *Lack of information will delay your telehealth booking. *
Relevant history to the situation: *Lack of information will delay your telehealth booking. *
What Type of Medication Charts Do You Use?: *