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

    MEDICARE CARD EXPIRY

    REF#

    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:

    Have you, or anyone in your household, had a COVID swab in the last 14 days? NoYes

    CONSULTATION FEES

    Description

    Fee

    Medicare Rebate

    Gap (approx.)

    New Patient

    $240

    $91.80

    $158.20

    Review

    $150

    $40.85

    $109.15

    Ear Toilet

    $200
    ($90 for 2nd ear)

    $102.85
    ($51.45 for 2nd ear)

    $97.15

    Nasendoscopy

    $240

    $114.90

    $120.10

    Nasal Cauterisation

    $200

    $84.25

    $115.75

    Transtympanic Therapy

    $300 (1st Injection)
    $200 (subsequent) +$50 per vial

    $134.80

    N/A

    Telehealth Initial Consultation

    $140

    $76.80

    $63.20

    Telehealth Subsequent Consultation

    $95

    $40.85

    $55.15

    Medical Report

    From $200 + GST
    (fee may vary dependant upon complexity)

    N/A

    N/A

    Hearing Test (Adult)

    $140

    $51.55

    $88.45

    Hearing Test (Child)

    $105

    Current Fees from May 2023 and subject to change without previous notice.

    Please note, we only accept EFTPOS payments. We do not bulk bill

    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.