1. Patient Registration Form

Patient Registration Form

Fee Policy: There is a consultation fee and this is payable on the day of consultation. Failure to attend/ missed appointments, without prior contact to the office may incur a fee. By signing this form, you are agreeing to the fee policy. Surgical fees are discussed only if surgeon has recommended a procedure.

Privacy Statement: This practice handles personal information in accordance with the NSW Health Records and Information Privacy Act. I consent to the handling of my information by this practice for the purpose of providing quality health care, associated administrative and billing purposes, give permission for medical information to be obtained from any other source in order to help with my treatment. I also give permission for medical photography to be used for planning procedures and follow up. Use for teaching, audit research or publication would require additional consent to be obtained. We require you to provide us with your personal details and medical history so that we may 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 medical practice.
  2. Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.
  3. Disclosure to others involved in your health care, including treating doctors and specialists outside this medical practice as
    advised by you.