New Patient Form – Child

We are committed to providing our patients with the best care. To do this it is essential that your child’s health record is kept up to date and is accurate.

We ask that the parents or guardians of children at our practice complete an Authorisation to Communicate and Access with Other Parties Form on arrival at the practice. This form will become part of the child’s file and it is your responsibility to inform us if authorisation for an individual is to be revoked or changed.

Our practice provides our patients with preventative care and early case detection reminders such as immunisation, annual health checks, skin checks and pap smears.

To assist us in ensuring your Medical Record is accurate please complete the following Medical Questionnaire

Has anyone in your close family suffered from the following? (Please state the relative affected e.g. mother, father, sister, brother, maternal grandmother, paternal grandfather)

To ensure that we provide the best protection to your child we may ask you to provide evidence of court orders, agreements or parenting plans.