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:
We respect your privacy and will not disclose any information to anyone without your prior approval unless it is clinicians and hospitals directly involved with your treatment / care.
I give authorisation for disclosure of my records or treatment with the following next of kin(s):
(This information guides fitness for procedure decisions).
(This background might suggest the appropriate treatment format).
Thank you for completing your confidential patient registration form. One of our team will get back to you shortly to discuss your appointment.