New Patient Form

Please complete the details below. Alternatively, you can download and print a PDF form here.

    Patient Registration Form



    Birth Gender

    Ethnicity: Do you identify as

    If yes, are you registered for Closing the Gap (CTG)?

    Do you require an interpreter? (Ph 131540)

    IN CASE OF EMERGENCY(if different to next of kin)

    Do you have any allergies?

    Do you smoke?

    Do you consume alcohol?

    How did you find us?

    Health Information Collection and Use Consent – please read carefully before you sign

    Why and how we collect and use your personal information.

    As a patient of our medical practice, we require your personal details and a full medical history in order to properly assess, diagnose, treat and be proactive in your health care. We aim to protect the privacy and securely store your health information. You can request a copy of our privacy policy, which includes information about the collection, use and disclosure of your health information.

    This practice will use and/or disclose your information for the following:

    • Administrative purposes in running our medical practice.

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

    • Disclosure to others involved in your healthcare including treating doctors, specialists, nurses and allied health professionals outside this medical practice. This may occur though referral to other medical providers or for medical tests, as well as in the reports or results returned to us following referrals.

    • Disclosure to other medical professionals in the practice including locums attached to the practice for the purpose of patient care and teaching.

    • For research and quality assurance activities to improve individual and community health care and practice management. Usually, information that does not identify you is used but should information that may identify you be required you will be informed and given the opportunity to opt out of any involvement.

    • To your employer in the case of employment or pre-employment health checks and to their insurance providers in the case of workers’ compensation claims.

    • To comply with any legislative or regulatory requirements e.g. notifiable diseases.

    • For follow-up recalls and/or reminder letters for treatment and preventative health. This may be done by mail, phone, or SMS.

    I give permission for next of Kin/Emergency contact/Partner to obtain personal information on my behalf:

    You can decline to have your health information used in all or some of the ways outlined above but it may influence our ability to manage your health care to the highest standards.

    For Patients

    Your First Appointment

    New Patient Form


    Frequently Asked Questions

    Practice Information

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