appointment request

You can save your appointment request and come back to it at any time. Scroll to the bottom of the form and click "save and complete later".

First Name *

Last Name *

DOB *

Email Address *Please double-check your email address or we may not be able to contact you!

I am located: *

in Australiaoutside Australia/ International

Mobile number *Australian mobile numbers only.

Mobile number (international) *International mobile phone numbers must include the country code

Preferred form of contact? *

MobileEmail

Postcode *

Country of residence *

Type of consultation *

In-person consultationVideo consultation / telehealth

Please note that video consultations/ telehealth appointments are reserved for patients who live interstate, or more than 1hr from Adelaide.

Are you available at short notice? *

Yes, always.No, never.Maybe, it would depend on the day/time.

We occasionally will have cancellations and appointments may become available. This may allow you to be seen sooner. Our staff can contact you if a space opens up and you have selected 'yes' or 'maybe'.

Do you have Australian private insurance with hospital cover? *Please note that you do not need to have insurance to have surgery. You will still receive Medicare rebates where applicable if you don't have insurance.

Please select the operation you are interested in: *Please choose the most appropriate answer from this list. If you are interested in multiple procedures (eg. breast implant removal AND fat transfer or breast lift) let us know below.

When would you like to have surgery? *

Please tick here if you intend to access your superannuation (where applicable) for surgery?

Referral

Do you need a referral to see Dr Campbell-Lloyd?A referral should be provided by your regular GP or a referring specialist. Please note that a referral does not automatically entitle you to a Medicare rebate for your consultation.

Your Referral:

Browse

If you have a referral, you can upload it here. Please ensure the referral is either a .jpg image or a .pdf document. If you are seeking COSMETIC surgery, please note we will not allow appointment bookings until you have a referral.

New cosmetic surgery requirements (from July 1 2023)

The procedure you have selected is considered to be Cosmetic, or may not have an applicable item number. This includes cosmetic fat transfer for breast augmentation, cosmetic breast lift/mastopexy, or cosmetic breast implant revision surgery.

Please note: Medicare rebates are not applicable for consultations with Dr Campbell-Lloyd regarding purely cosmetic procedures. If you discuss multiple different procedures and this includes discussion of both cosmetic AND "medically necessary" procedures, then a Medicare rebate may apply. This can only be determined after your consultation.

From July 1 2023, new regulations require that patients seeking purely cosmetic procedures complete additional steps, including:

a screening assessment for Body Dysmorphic Disorder, and
a separate consent for the use of clinical photography.

We ask patients considering cosmetic procedures to follow the links below to complete these additional steps. This will only take a few minutes of your time. Once the extra forms (which will open in new tabs) have been submitted, you will need to return to this tab to complete your appointment request.

BDD screening assessment

Consent to the use of clinical photos

I have completed the screening assessment for Body Dysmorphic Disorder by following the link above.
*

I have signed the Consent form for the use of clinical photography at the link above.
*

Previous surgery

If you have had any type of breast surgery in the past, please tick this box. You will be prompted to answer some more questions.

I have breast implants currently

Please tell us what you know about your implants *Please provide any information you have about your implants. This may come from the implant card you received after your last surgery. If you don't have any information, that's ok! Just say "I don't know"

Have you had any other breast surgery? *You can select multiple answers for this question.

Please tell us a little more about yourself:

Height *please ensure you have entered your height in metres, NOT in centimetres

Weight *

BMI calculation

Please note: We are not able to offer appointments to patients who are not at a safe surgical weight. For patients with a BMI greater than 32, we will recommend that you discuss your options for weight loss with your GP prior to requesting an appointment. Thanks for understanding.

Do you currently smoke, vape or use any nicotine containing product ? *

Yes, dailySometimes, sociallyNo, never

Please be completely honest. Even occasional nicotine use can alter surgery outcomes. All patients MUST be nicotine free before we will allow surgery to be booked. This includes nicotine replacement therapy such as gum or lozenges.

How did you hear about us? *

We strongly recommend that all patients check the online price guides on our website prior to an appointment. Please follow the link below.

Dr Campbell-Lloyd's surgery prices

Thanks for completing this form. Please click 'Submit' below. Your appointment request will be received and we will be in touch by email or phone to arrange a time that suits.

Save and Complete Later