Patient Registration

Please provide the following details to make your appointment as seamless as possible.

Patient Registration

Your Details

Emergency Contact Details

Referring Doctor

Is this your Family Doctor / GP?

Medicare, Private Health Insurance, DVA Details, Concession Details

Do you have private health insurance
Veterans Affairs
Do you have a Concession Card (eg. Pension/Seniors/Healthcare Card)

Work Cover, Compulsary Third Party Details

Is this related to Work Cover, Compulsory Third Party
Has liability been accepted for this injury?
Do you have written prior approval for this consultation from your Insurance Company?

Allergies

Upload Documents (e.g. GP referrals, Radiology Reports, WorkCover Approval)

Maximum file size: 15MB

pdf, jpeg, png, gif files accepted. Max file size 15mb.

Communication Consent & Information Preferences

Payment for Consultations is required at the time of your Visit and can be made by Cash, EFTPOS (Visa or Mastercard). AMEX not accepted.

Initial Consultation: $200.00
Subsequent: $100.00

This Medical practice collects information from you for the primary purpose of providing quality health care.
We require you to provide us with your personal details and medical history so that we can properly assess,
diagnose, treat and be proactive in your health care needs. We will use the information you provide in the following ways: 1. Administrative purposes in running our practice.

  1. Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.

  2. Disclosure to others involved in your health care, including treating doctors and specialists outside this medical

practice as advised by you.

  • I understand the reasons why my information must be collected.

  • I understand that I am not obliged to provide any information requested of me, but that failure to do so might

    compromise the quality of the health care and treatment given to me.

  • I am aware of my right to access the information collected about me, except in some circumstances where access

    might be legitimately be withheld. I understand I will be given an explanation in these circumstances.

  • I understand that if my information is to be used for any purpose other than the above, my consent will be sought.

  • I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations

    on access or disclosure of which I may notify this practice.

Communication & Information Selections

How did you hear about us? *

Your First Visit?

Coming to our practice for the first time, explore our information for new patients.