QUEENSLAND’S
Trusted Circumcision & Vasectomy Clinic
SMS ENQUIRIES 0409 632 693 OR PHONE 07 2103 2322
TEEN TO ADULT CIRCUMCISION ONLINE REGISTRATION - 15+ YEARS OF AGE
WHAT TO DO IF YOU DON’T HAVE SOME INFORMATION REQUESTED ON THE REGISTRATION FORM?
For any numeric field you do not have enter 0 | For any text field you do not have enter X
It is important to know details about a patient’s medical history, as it forms part of vital records for treatment with Gentle Procedures Clinic. All fields are mandatory to ensure a complete record.
The information you provide is confidential and will be handled per our Privacy Policy.
By completing, signing & submitting the form, you are making an informed consent to the procedure being performed on the date of your appointment.
If you do not consent to some or all of the sections, do not complete or submit the form and contact our office to discuss 07 2103 2322.
