Which tests, and why

The tests that come with the review

Standard blood tests and screening are ordered under Medicare where there's a clinical reason for them — the same rules your GP works to — so there's no cost to you for those. Lipoprotein(a), a once-in-a-lifetime test no standard GP request includes, is offered when something in your history makes it useful (about $30 to $60 to the lab). ApoB is added to the cholesterol check from 40, or earlier with risk factors. We take a sexual and exposure history first, and the blood-borne virus and sexual health tests — hepatitis B and C, HIV and syphilis — follow from it, covered by Medicare. The guideline's list of who should be tested is broad, so most men are; the difference is that the reason is recorded rather than assumed. Whether it's repeated depends on the same history. If your waist is up, you drink, or you have diabetes, we add liver tests and calculate a FIB-4 score from them at no extra cost: it's the one number that tells us whether fatty liver is the harmless kind or the kind worth chasing. If you're short of breath, coughing or working around dust, we do a breathing test. From 50 there's a quick hearing screen — a question or a free app — five-yearly to 64 and then every one to three years, with a referral to an audiologist only if it's positive. A two-yearly eye check with an optometrist starts at 50, or at 40 if glaucoma runs in your family or you have Asian or African ancestry. Anything else that isn't covered is explained, with its cost and reason, before it's ordered, and where a scan or fitness test is needed we book it for you.

Optional tests

Medicare doesn't cover these. Each is suggested only when it would change a decision, explained before it's ordered, and paid directly to the lab or clinic, $30 to $300. Most people need one or two of them, not all — and many need none.

If you're starting weight-loss treatment or a training program, a baseline physical of DEXA and VO₂ max at partner clinics (about $300 to $500, paid to them) is booked from the review and the results come back to your second visit.

• Lipoprotein(a)once · about $30–60An inherited cholesterol particle a normal test doesn't show. Offered once when your history gives a reason: a close relative with early heart disease or a known high level, a heart problem of your own despite normal cholesterol, very high cholesterol, or a heart-risk score where the decision about a tablet is open.
• ApoBwith your cholesterol test · $15–50With the cholesterol check from 40, or earlier with a large waist, high triglycerides or family history. Counts cholesterol particles, a closer measure of the particles that cause heart disease.
• Coronary calcium scoreonce · $100–250Ages 40 to 75 when your calculated heart risk is in the middle and the decision about a cholesterol tablet is open. A ten-minute heart CT that measures plaque directly.
• Fitness test (VO₂ max)baseline · $185–300If you're sedentary or starting a training program and want exact zones to train in. Repeated only after months of training.
• Body composition scan (DEXA)baseline · $120–200If you're starting weight-loss treatment or a program, to make sure you lose fat and keep muscle. Also when weight and waist tell different stories. In Victoria this scan needs a doctor's referral, which the review provides.
• Liver scan (FibroScan)Medicare when criteria are met, otherwise $150–300Only if your FIB-4 score comes back raised. A painless ten-minute probe that measures how stiff the liver is, which is the part that matters. A normal result ends the question.
• Sleep studyMedicare-covered when criteria are metIf you snore, wake unrefreshed or score high on a short questionnaire. Under-diagnosed and highly treatable.

What the pre-appointment form asks

Eleven sections, and only the questions that apply to your age — about 56 for a man in his fifties. Your family: heart attack or stroke before 60, sudden cardiac death, diabetes, bowel and prostate cancer by the pattern the guidelines define, glaucoma, kidney failure, a parent's hip fracture, aneurysm, haemochromatosis. Your health: fifteen conditions, from diabetes and blood pressure to the ones that quietly move a screening age — coeliac disease, long-term steroids, a weakened immune system. Then: smoking and how much, alcohol against the Australian guideline, activity and strength work, noise and dust at work, mood and sleep, sexual health, and the things you've noticed yourself — vision, hearing, skin, feet, falls, memory.

Every answer moves something specific. "Not sure" is an answer, and an unanswered question stays unanswered rather than being read as "no".

The form itself, to fill in once you've booked.

Where we offer more than the Red Book

The RACGP Red Book is the floor. In six places the schedule offers more than it does. Each is a deliberate position. Most rest on another named guideline; two, VO₂ max and DEXA, rest on cohort evidence alone and are offered only on request.

• Blood count, ferritin and iron studies, once at baselineMedicareThe Red Book supports iron studies only as case finding for haemochromatosis. Offered here as a single baseline that also detects anaemia and C282Y-related iron overload, at negligible cost when other bloods are already being drawn. Source: RACGP Red Book, haemochromatosis chapter.
• Eye examination, two-yearly from 50Medicare optometryThe Red Book grades visual-acuity and glaucoma screening in the general population as generally not recommended, supporting case finding on a named risk list. Sources: Optometry Australia policy position, and Glaucoma Australia, which brings the check forward to 40 with a family history or Asian or African ancestry.
• Hearing screen from 50FreeThe Red Book: "Screening for hearing loss is not recommended in asymptomatic adults aged ≥50 years." Sources: the AAO-HNSF Clinical Practice Guideline on Age-Related Hearing Loss (2024), which screens from 50, and WHO's Hearing screening: considerations for implementation (2021), which sets the interval used here.
• Coronary calcium score, 40 to 75Private, ~$100–250The Red Book grades CAC for population CVD screening as not recommended, its strongest negative. That grade is against screening everyone; this is offered only to reclassify a calculated risk of 5–15% where the statin decision is genuinely open, which is the position of the 2023 Australian CVD risk guideline.
• Lipoprotein(a), oncePrivate, ~$30–60The Red Book states there is currently no justification for Lp(a) screening in the general population. This is targeted testing on a risk-enhancing feature, not screening. Sources: the 2025 ESC/EAS focused update (Class IIa, Level B) and the Australian Atherosclerosis Society position statement.
• Liver panel with FIB-4, ApoB, AAA ultrasound, VO₂ max, body-composition DEXAMixedNo Red Book recommendation exists for any of these. Each rests on another guideline: FIB-4 on the AASLD, EASL and GESA risk-stratification pathway in metabolic risk; ApoB on the 2023 Australian CVD guideline and ESC/EAS; AAA on USPSTF and international vascular guidance. VO₂ max and DEXA rest on prognostic cohort evidence only, are not screening, and are offered on request with the price stated first.

Where the schedule goes beyond the guideline, it says so on the item itself and the reason is explained at your visit.