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ONLINE PATIENT REGISTRATION FORM

Sunshine Coast University Private Hospital

Consulting Suite 12
3 Doherty St, Birtinya Q 4575

Sunshine Coast Orthopaedic Group

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Patient details

Name*
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Postal Address*
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Patient history

Please tick if you are taking any of the follow medications*
Previous surgical procedures
Procedure
Year
 
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Privacy Policy

As a health care provider in the private sector, the Sunshine Coast Orthopaedic Group is bound by the National Privacy Principals provided in the Privacy Act 1988. These govern how we collect, handle, use, distribute and store personal information collected from our patients at the clinic. Ordinarily we do not release the contents of your file without consent. When dealing with other health care professionals, in order to obtain accurate diagnosis or treatment options we will ask your full consent to disclose personal medical details. Please indicate below and sign your consent for details to be disclosed when necessary.

Give permission for details relating directly to my medical condition to be discussed, if necessary, with other health care professionals.*

NOTICE: Your actual signature to confirm the information provided in this form will be requested in person when you visit us.

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