Language / Nationality Details
Concessions & Private Health Details
If you are under 17 years of age please fill out the below medicare details for billing purposes
Next Of Kin Details
Please also be aware that while we offer a recall service for some pathology and reports received, it is still the responsibility of the patient to contact us regarding obtaining results.
Please note, our practice utilises TYRO for claiming and payments of services. Unless arranged prior to your appointment, this requires the full consult fee (including any non-reimbursable gap payment), to be paid on the day. All Pension, Concession Health Care Card holders, DVA Card holders and children under 17 years will be Bulk Billed
It is the policy of the practice to only provide results to yourself or any relevant practitioners involved in your treatment for specific reasons (e.g. referred Specialists, Allied Health, compensation providers etc.). If you wish to authorise any other representative on your behalf Please list them below
Do you have a copy of your referral? Please take a photo of it and upload it so we enter all your information before your appointment.
Please also bring your referral on the day