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

You can click the Month and Year labels at the top of the calendar to quickly change the date.

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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