Patient Registration Form

Consent

We are collecting your record according to the Health Records and Information Privacy Act 2002. Please read and sign to give approval for this information to be collected and stored. Your medical information will be used exclusively for providing health care in the following way:

• To gain a history, diagnose disease and provide treatment where necessary
• Administrative purposes in running this Practice, which may also include confirmation of your appointment
• Writing reports to your Doctor and other Doctors involved in the provision of healthcare, and the storing of reports provided to this Practice by other Medical Specialists
• Billing and collection purposes, including but not limited to compliance with Private Health Fund, Medicare and Health Insurance Commission requirements
• You may gain access to your health information by writing to us

If you do not consent to providing us with your health information we may be unable to provide you with health services.