SECURE BOOKING

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STEP 1 OF 2

Your details

Complete the intake details used for a Longevity GP booking. They are held in a restricted clinical-portal queue so authorised staff can transfer them to PracSuite. Your signature and attachments are available only to Dr Colin Coward and are permanently deleted from Supabase when he deletes the booking intake.

Client details

First name Last name Email Phone

Date of birth

Day Month Year

Medicare details Optional

Medicare Number Medicare Card IRN Medicare “Valid To” date

Contact and care Address Add your message Usual GP Doctor’s name and practice name

My Health Record consent

Do you consent for Dr Colin Coward to access your My Health Record?

Yes, I consent No, I do not consent

Signature

Type your full name

Medication or supplement photo OptionalUpload a photo of your regular medications/supplementsJPEG, PNG, WebP, HEIC or HEIF, up to 4.5 MB. It is stored privately, available only to Dr Colin Coward and deleted from Supabase with the booking intake.

STEP 2 OF 2

Choose your consultation time

Select an available 30-minute consultation with Dr Colin Coward. Times are shown in Perth time.

AVAILABLE TIMES

Doctor diary

AUSTRALIA / PERTH

LOCATIONO2 Active, 1/124 Stirling Hwy, North Fremantle WA 6159

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Select an appointment time.

BOOKING COMPLETE

Welcome to Signal Health.

Your appointment has been booked. Your intake is ready for authorised staff to transfer securely into PracSuite.

YOUR UNIQUE SIGNAL HEALTH IDENTIFIER000000

Keep this six-digit identifier safe and secure.

Record it somewhere separate from your name, address, date of birth and other demographic details. You will use it whenever you sign in to your private Signal Health portal.

You will now be taken to your unique portal. After choosing a password and setting up two-factor authentication, the portal will open at your detailed health questionnaire. Completing it will make your consultation a richer and more valuable experience.

I have recorded my six-digit identifier securely and understand that I must keep it separate from my demographic details.