Patient Registration

Patient Registration

  • Child's Details

  • Legal guardian details

  • I give consent to the above practice to collect health information for the purpose of assessment, diagnosis and treatment in respect to the health of my child. I understand it may be necessary to disclose information to a third party when it forms part of the treatment for the original condition. Disclosure may be necessary if the child is referred to another medical or allied health practitioner. I also understand that payment is due on the day of appointment and it is my full responsibility to ensure that all details herewith are correct and current.