Contact

Australia's only private CyberKnife® Clinic.

Perth

5D Clinics Perth

Address

261 Stirling Highway
Claremont, Western Australia 6010

Contact

Phone 1800 532 927
Email info@5Dclinics.com.au
Fax: (08) 6244 8699

Clinic Opening Times

Mon - Fri 9.00am - 5.00pm
(Consultations and Treatment)

Albany

5D Clinics Albany

Address

Great Southern Specialist Centre
55 Cockburn Road
Mira Mar WA 6330

Contact

Phone 1800 532 927
Email info@5Dclinics.com.au
Fax: (08) 6244 8699

Clinic Opening Times

By appointment only.
(Consultations only)

Contact Form

Complete the form below, and one of our experienced medical professionals will be in touch with you.

"*" indicates required fields

Contact Details

1. Patient name*

2. Patient DOB*

3. Contact name (if different from above)

4. Contact email*

5. Contact phone number*

6. Are you in Australia

Yes

7. Postcode

7. Country

Relevant Information

1. Primary diagnosis

2. Body sites for assessment of CyberKnife® e.g. prostate, liver, brain*

3. Clinic location of latest imaging scans

4. Date of latest imaging scans

5. Previous radiation

Yes

Previous radiation details

Enquiry Details

Please enter the details of your enquiry

Supporting documents

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Max. file size: 32 MB.

Consent

This form authorises 5D Clinics representatives to legally request and receive your medical information from third party providers, including but not limited to, Medical imaging reports, Biopsy reports, Histopathology, pathology reports, medical letters and previous radiotherapy treatment details.

Patient Signature