Our practice uses text messaging as a form of communicaiton, please choose and initial if you consent to us contacting you for;
Our practice uses email as a form of communication, please choose and initial if you consent to receiving emails.
Please note: Email and SMS forms of communication are not encrypted. This means the email and SMS are not secure. Agreeing to receieve private and confidential results, recalls or correspondence is at your own risk.
Allergies: Do you have any allergies? (food, tablets, insects, other) are you sensitive to any drugs or dressings?
Medications: Are you currently taking any medications? (including over the counter medication and the pill)
PLEASE NOTE WE ARE A PRIVATE BILLING PRACTICE. PAYMENT OF YOUR ACCOUNT WILL BE REQUIRED ON THE DAY.
Privacy: This practice is committed to maintaing the confidentiality of your health information at all times. This information will only be available to authorised staff members.
I have read the information above and understand the reasons why my informatiion has been collected, I am also aware that failure to provide any information may comprimise the quality of health care and treatment that is given to me.
