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Patient Registration

Title
Surname(Required)
MM slash DD slash YYYY
First name/s(Required)
Birth Sex
Gender identity

Cultural background

Knowing your cultural background can help us provide healthcare that meets your individual needs.

Are you of Aboriginal or Torres Strait Islander origin?
Is English your first language?
if not, do you require an interpreter?
Address(Required)
Please enter a number less than or equal to 10.
Please enter a number less than or equal to 10.
MM slash DD slash YYYY
Please enter a number less than or equal to 10.
MM slash DD slash YYYY
Please enter a number less than or equal to 10.
MM slash DD slash YYYY
Please enter a number less than or equal to 10.
MM slash DD slash YYYY
MM slash DD slash YYYY
Next of kin(Required)
Emergency contact ?
Do you consent to SMS reminders ?(Required)
Do you consent to SMS Recall & Test Reminders ?( No Health info. included in SMS )
What is your preferred method of contact ?
I confirm that the information I have given (on this form) is correct. I consent to sharing of all relevant information between the general practitioners, specialists, nurse practitioners, nurses, allied health providers and non-clinical staff for the purpose of managing my health. I understand this information will be used to fulfil their duties in the course of planning and managing my health care.
Do you consent to receive news, information about services, promotions and offers from us (and our third-party partners) and consent to your personal or sensitive information being used for this purpose? You may unsubscribe from these communications at any time
PARENT OR GUARDIAN DETAILS (Please complete this section if child is under 17 years of age)
Emergency contact ?
MM slash DD slash YYYY
Please enter a number less than or equal to 10.
Please enter a number less than or equal to 10.
MM slash DD slash YYYY
Add this to the form as well -

Privacy and Confidentiality Statement

This practice collects your personal information to support the delivery of healthcare services by your practitioner. This includes communicating with you, informing you of relevant services, and managing your care. Providing accurate information is important—without it, we may be unable to facilitate care effectively.

Your medical record is a confidential document. We are committed to protecting your personal health information in accordance with federal and state privacy laws, including the National Privacy Principles. Your information is securely stored and only accessed by authorised staff.

We may share your information with your health practitioner, related bodies corporate, and trusted third-party service providers as needed to support your care.

By signing this form, you acknowledge our privacy practices and, where your consultation is bulk billed, you consent to assign your Medicare benefits to the practitioner who provided the service.

For full details on how we handle your personal information—including access, correction, and complaints—please visit our website or ask our reception team for a copy of our Privacy Policy.

We give you the opportunity to participate in your health care and be in control of your health. We give you practical and easy tools to improve your energy levels and overall physical and emotional fitness.

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Contact Info
Our Clinic Hours

Mon: 8:30am to 9pm
Tue: 8:30am to 9pm
Wed: 8:30am to 9pm
Thu: 8:30am to 7pm
Fri: 8:30am to 9pm
Sat: 8:30am to 5pm
Sun: Closed

GP Services

Mon: 1pm to 9pm
Tue: 6:30pm to 9pm
Wed: 6:30pm to 9pm
Sat: 12pm to 5pm

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Care outside Normal opening Hours

For After Hours services, Hello Home Doctor can be contacted on 134 100. Alternatively, The Prince Charles Hospital Emergency Department or Brisbane Northside Emergency are available to our patients who are in need of medical care outside of our normal opening hours.
For urgent medical attention or in an emergency, please call 000.

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