For patients

Confidential patient registration form

Welcome to our practice. For our confidential records and to assist in determining your treatment, please answer the following questions as accurately as possible.

Fees are the responsibility of the patient, parent or guardian. Consultations and surgical procedures in the rooms are required to be paid at the time of your visit.

Please either download and return our Confidential Patient Registration Form or submit your information securely online below:

Patient details


Account Responsibility


Emergency Contact


Medicare and private health insurance


Other Eligibility


Medical GP / Clinic contact details


Dentist / Clinic contact details

Get in touch

Please fill out the form below to book a consultation at Precision OMS’s Geelong offices.

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