Complete Your Registration Before Your First Appointment

Patient Registration Form

Health Insurance Details

Select your health fund from the drop down list. If not listed, please put enter below

Enter your health fund if not in the drop down list

Other Details

This is a private specialist practice and there is an out-of-pocket cost for consultations. Accounts are payable on the day of consultation. We accept payment by cash, cheque, credit card (MasterCard, Visa, AMEX) or EFTPOS.


We use a debt recovery service for overdue accounts, which will incur additional costs.


The practice has policies with regards to privacy and health information. It may be necessary to share personal or medical information with other practitioners who are involved in your care. This is in accordance with the Health Records Act (Vic) 2001 and the National Privacy Principles in the Privacy Act (Cwlth 1998).


By pressing the submit button, you agree to these terms.

If you require any assistance with your registration, please contact (03) 9418 8210.

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