Connecting with eluceo

Name *

First Name

Last Name

I confirm that I am the person seeking care at eluceo *

eluceo requests that individuals seeking care contact us directly to learn more about our services

Yes

I confirm I am over 18yrs of age *

eluceo’s clinicians provide support exclusively for adults

Yes

Please Note *

I understand this is an un-encrypted form which is used primarily to arrange and prioritise appointments and should not be used clinical enquiries. I understand this information will be uploaded into my clinical record.

Yep - I agree

Fees *

I confirm that I have read the fees for the service I am enquiring about.

Yes