New Patients

We invite you to fill out the patient registration form below online in advance to make your appointment experience even smoother. We require all patients to register prior to seeing a specialist.


PATIENT REGISTRATION FORM

TITLE: MRMRSMSMISSMASTER

SURNAME

GIVEN NAMES

DATE OF BIRTH

TELEPHONE (HOME)

(MOBILE)

(WORK)

EMAIL ADDRESS

ADDRESS

POST CODE

MEDICARE

REF#

VETERAN’S AFFAIRS (IF APPLICABLE)

DO YOU HAVE PRIVATE HEALTH INSURANCE NoYes

NAME OF FUND

MEMBERSHIP No.

NEXT OF KIN

TELEPHONE

PARENT/GUARDIAN DETAILS (If patient is under 18 years old)

NAME

ADDRESS

POST CODE

TELEPHONE

DATE OF BIRTH

MEDICARE

REF#

Do you suffer any drug allergy? NoYes

Please specify:

CONSULTATION FEES
Description Fee Medicare Rebate Out of pocket (approx.)
New Patient $225 $73.85 $146.15
Review $125 $37.15 $82.85
Ear Toilet $165 ($85 for second ear) $93.45 ($46.72 for second ear) $66.55
Nasendoscopy $205 $104.45 $95.55
Nasal Cauterisation $145 $76.50 $63.50
Nasal FB Removal $125 $69.95 $54.05
Bronchoscopy $280 $151.35 $128.65
Spirometry $150 $117.90 $32.10
Replacement Prescription Fee $5 N/A N/A
Hearing Test (Adult) $120 $46.90 $73.10
Hearing Test (Child) $80 $38.70—$46.90 (depending on tests performed) $33.10—$41.30

Please note, we only accept EFTPOS payments.


*Prices correct as of 1st January 2019 and subject to change without previous notice.

**After 1st of July 2014 this medical practice no longer offers concession card discounts, pensioner card discounts or bulk billing.






By ticking this box you acknowledge our Consulting fees and agree with our Privacy Policy. Should you have any enquiry please contact the front desk staff before signing this document.

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