New Patient Registration

Once the receptionists has made an appointment for your child, you can conveniently register your child as a new patient by using this online registration form. Our reception staff may contact you to confirm details.

Please note: items marked * indicate mandatory fields. Patient refers to the child that will undergo consultation and/or treatment.
Patient Details
Parent or Guardian (1) Details

If no Medicare number please enter '0' in Medicare Number field and '0' in Medicare IRN field.

Parent or Guardian (1) Contact Details
Parent or Guardian (2) Details
Parent or Guardian (2) Contact Details
Memberships (relating to patients)
General Practitioner details
Referring Healthcare Provider Details