I confirm that the above details are true and correct. I acknowledge that I have read and understand the Policies and Procedures outlined on the Practice Information Sheet. I understand this is a private practice and full payment is expected on the day of consultation and that late fees may be billed if I do not pay on the day. I understand that reception can assist with any queries I might have with the Policies and Procedures outlined in the Practice Information Sheet.

Consent to receive the SMS messages which can include accounts, appointment reminders, clinic reminder messages (please note you can revoke your permission at any time).

Consent of sharing my information that has been collected to other providers (such as pathology, physiotherapists, other GPs, Specialists and Medicare for billing purposes etc.) in order to provide appropriate care, support and services according to my needs.

Please Note: Your consent to share information is valid indefinitely or until otherwise altered/revoked. We also must comply with any legislative or regulatory requirements and notifiable diseases also please note it is your responsibility to keep all personal information up to date and follow up on all test results in person.