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NEW PATIENT FORM

New Patient Form

Do you have a concession card?
How did you hear about us?
We regularly follow-up on scan results and referrals, do you consent for us to contact your Doctor?

Cancellation and Payment Policy

I acknowledge that I am required to give a minimum of 24 hours’ notice to change or cancel an appointment. Failure to do so will incur a cancellation fee of $50.00.

 

Payments are required on the day. I acknowledge that it is my responsibility to provide up to date concession eligibility information. In the instance where a concession card has expired, I will repay the gap for a full fee consultation where applicable. 

Please sign below to acknowledge that you understand and agree to the above information. 

Thanks for submitting your info!

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