Benedict Medical Service Request Form



All sections must be completed for appointments to be processed.



Requestor Details



Participant Details


At least one phone number is required



Service Details



Participant Availability



Please select at least 9 hours over a minimum of 2 weekdays. If you would like to add additional days to your selection please click on +.

Injurynet will book the participant's medical based on the date and times you have provided. Please note, all cancellations and non-attendances will incur a fee.