We require your consent to collect personal information about you. Please read this information carefully before completing our registration form.

This medical practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and a full medical history so that we may properly assess, diagnose, treat and be proactive in your healthcare needs. This information will be maintained on a computerised database to ensure your details are accurately and efficiently recorded. This database will only be accessed by your doctor and clerical staff at the practice who are authorised to do so.

We will use the information you provide in the following ways:

  • Administrative purposes in running our medical practice including telephone confirmation of appointments
  • Billing purposes, including compliance with Medicare and Health Insurance requirements
  • Disclosure to others involved in your health care, including treating GPs, specialists and allied health professionals outside this medical practice. This may occur through referral to other health professionals or for medical tests, and in the reports or results received.

Please let us know if you do not want your records accessed for these purposes and we will note your request accordingly.

I have read the information above and understand the reasons why my information must be collected. I am also aware that this practice has a privacy policy on handling patient information.

I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of the health care and treatment given to me.

I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.

I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.

I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify this practice of.

I consent to the use of non-identifying clinical photographs for educational purposes only. Further information on our privacy policy is available by request.


Payment for your consultation is required in full on the day. Cash, EFTPOS, VISA, or Mastercard are accepted.

I accept that if I default on my account, my details will be passed onto a Collection Agency or Solicitor. I agree to pay all fees and legal costs associated with the collection of such accounts. In the event of outstanding accounts, I understand that my next of kin will be contacted for payment.