In order to confirm your appointment we do request a complete medical history on the person having a procedure with Gentle Procedures Clinic Queensland, please complete all fields. All information provided is confidential and will be handled in accordance with our Privacy Policy. We appreciate your assistance and completing this as soon as possible.

By completing the electronic form and signing it electronically you are making an informed consent to the procedure being performed on the date of the appointment.

For any person aged 15+ you must ensure you complete the form and that you have made an informed decision to have the procedure performed.

If you do not consent to any of the questions within the form or wish to discuss further with a doctor do not complete the form and contact our office.

Adult Circumcision Registration Form