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About Us
Meet the Team
Services
Join Us
Referrers
Patient Resources
Ultrasound Scans
Pregnancy Calculator
FAQ’s
Costs
Contact Us
Online Registration
To register for your appointment, please complete the form below.
Booking Details
Appointment Booked?
Is your appointment booked in?
Yes
No
Type of Appointment
What type of appointment is required?
Obstetric
Gynaecology
Last Menstrual Period Date (LMP) Date
Last Menstrual Period Date (LMP) Date
Personal Details
Name
Preferred Name
Date of Birth
Date of Birth
Street Address
Suburb
State
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Mobile
Email
Insurance Billing Details
Medicare Number
Medicare Reference
Referring Doctor
Clinic
Doctor
Street Address
Suburb
State
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Phone Number
How did you hear about us?
Referral method
Privacy Statement & Consent
In order to provide you with the highest standard of obstetric care, we will ask for personal information from you. This information covers basic details such as your name, address and telephone number but it is also necessary to know about your general health and past medical or surgical events. Without this general health picture, we are unable to plan your care properly. Naturally, some of this information is of a personal nature and some of it might be regarded as ‘sensitive’ and not the sort of information that you would wish to be necessarily disclosed to others. We value the need to safeguard this information, and in accordance with the principles laid down in privacy legislation and the guidelines issued by the Australian Medical Association, we would like to assure you that:
This information will only be used to individualise and optimise your care.
It may sometimes be necessary to disclose some information to other doctors and health professionals involved in your care (midwives or physiotherapists most commonly). They are also bound by the same privacy obligations.
It is usual practice to communicate with your referring doctor and other specialists involved in your care as this helps to ensure continuity of care. Please advise us if you do not wish for this to occur.
Your health information will not be disclosed to anyone not associated with your treatment without your express consent.
You may seek access to the information held about you and we will provide this access without undue delay. This access might be by inspection of your medical records at the time of appointment or by special access or copying of information at other times.
There will be no charge made for requesting this information but there may be fees levied to cover the costs associated with the processing of this request or copying of the information.
We will take reasonable steps to ensure at all times that the details we keep about you are accurate, complete and up to date.
We will take reasonable steps to protect this information from misuse or loss and from unauthorized access, modification or disclosure. Our records are stored electronically, on a secure server. All paper-based records that you provide will be scanned and then confidentially shredded.
Our staff are trained to respect these principles at all times.
If you have any questions regarding the information we collect from you, please do not hesitate to ask. We are acting in your interests at all times.
Privacy Policy Acceptance
I acknowledge that I have read, understood and agree to the privacy consent.
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About Us
Meet the Team
Services
Join Us
Referrers
Patient Resources
Ultrasound Scans
Pregnancy Calculator
FAQ’s
Costs
Contact Us