Patient Registration Form

New Patient Information Form

Personal Details

Do you have a different Postal Address?

Medicare/ Health Fund/ DVA Details

Do you have a pension card?
Do You have a DVA card?
Do you have private health insurance?

Next of Kin

GP & Specialists Details

About Your Symptoms



Medical Conditions

Medical Conditions

Previous Surgery


Consent Form for Collection and Use of Health Information

As a patient of our medical practice, we require you to provide us with your personal details and a full medical history,so that we may properly assess,diagnose,treatand be proactive in your health care needs.
We require your consent to collect personal information about you and to use the information you provide in the following ways. Please read this consent form carefully, and sign were indicated below.
* Administrative purposes in running our medical practice.
* Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.
* Disclosure to others involved in your healthcare including treating doctors and specialists outside
this medical practice. This may occur though referral to other doctors, or for medical tests and in the reports or results returned to us following referrals.
* Disclosure to other doctors in the practice, locums etc. attached to the practice for the purpose of patient care and teaching.
* To comply with any legislative or regulatory requirements e.g. notifiable diseases.
* For reminder letters which may be sent to you regarding your health care and management. 
You can decline to have your health information used in all or some of the ways outlined above but it may influence our ability to manage your health care to provide the best outcome for you.

Consent Options

Have a question about your condition or wish to book an appointment?

Please get in touch with our reception team if you have a general enquiry for Dr Parkinson, or your would like to book an appointment.