Complete Your Booking:
Patient Demographic Form
Please complete* this form within seven days of a
new patient appointment offer
a waiting list place offer
The requested information is necessary for contacting you, triaging, billing, Medicare, prescriptions, privacy and other clinical care. If accepting a Wait List Offer, your Medicare details can be left off the form until an appointment is offered.
Staff may not be able to enter the form into your file at the last minute if time is not available.
Completion of this Demographic Form and the Consent to Policies Form is required to accept a New Patient Appointment or Wait List Place Offer. If these are not completed within seven days, we will understand that you are declining the Offer, and we will withdraw the offer, close your child’s intake.
This form is required for New Patients or previous or continuing patients who have not been seen by any associated provider for several years.
Please complete the Patient Demographic Form below
if a New patient or
if your details have changed (e.g., parenting, address, phone numbers, GP).
You can also download the form to printout, complete and send it in via post or email, or ask our receptionists to post or email the form to you.
My Health Record (myHR)
Clinicians in the practice may have access to the My Health Records (myHR) of their patients, if the patient (or their parent/guardian) has not already opted out of having a My Health Record.
Your doctor may therefore view and/or upload to the patient’s My Health Record, unless you ask them not to.
The patient or parent/guardian may:
Ask the doctor not to upload documents/other information to the My Health Record.
Ask the doctor to delete something they previously uploaded.
Set their own privacy and security controls on the My Health Record through myGov. This may include setting a security code to prevent a doctor accessing the myHR unless you provide the code (unless it is an emergency situation).
Delete documents/records from the myHR through MyGov.
Parents can manage their child’s myHR until their child turns 14, at which point their access to their child’s record will be removed. Children aged 14-17 can specially nominate their parents to have access to their myHR if they wish.