Cummins South Pacific Medical Request Form

All sections must be completed for appointments to be processed.

Requestor Details

Participant Details

Service Details

Optional Services


Participant Availability

Injurynet will contact the participant to obtain their availability and location for the medical.

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, reschedules and non-attendances will incur a fee.