Patient Registration

Welcome to our new patient registration page. You may register with us online by completing the form below, or view our print version in PDF format, print and bring along with you to your initial consultation.

For more information about our practice and your initial consultation please contact us.

Please phone us on 03 9890 1844 to make an appointment.

Download print version

Personal details

Personal details

 

Person responsible for account

Person responsible for account

Medical history

Medical history

Please indicate if you have a history of the following?

Privacy Consent

Privacy Consent

We require your consent to collect personal information about you. Please read this information carefully.

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 a full medical history so that we may properly assess, diagnose, treat and be proactive in your health care needs. This means we will use the information you provide in the following ways:

  • Administrative purposes in running our medical practice, including telephone confirmation of appointments.
  • Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.
  • Disclosure to others involved in your health care, including treating doctors and specialists outside this medical practice. This may occur through referral to other doctors, or for medical tests, and in the reports or results returned to us following the referrals.
  • Disclosure to other doctors in the practice, locums and by Registrars attached to the practice for the purpose of patient care, teaching and research. Please let us know if you do not want your records accessed for these purposes and we will note your record accordingly.

 

Thank You

Thank you for your registration. We will be in touch with you soon.