In order to confirm your child’s appointment we request you complete the online patient registration form.

When you submit the form it will be encrypted and automatically transmitted to us, we then add the form to your child’s medical chart.

Please note most sections on this form require an entry, if you do not have the answer please enter N/A.

If you do not have a Medicare card for your child, please enter 0000000000 (mandatory 10 digits).

All information provided about your child is confidential and will be handled in accordance with our Privacy Policy.

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

If you do not consent to some or all of the consent; complications; privacy or release of information sections do not submit the form and contact our office to discuss – 07 2103 2322.

If you have a question or comment regarding the consent; complications; privacy or release of information sections please enter the details of your enquiry or concerns in each note section.

Child Circumcision (00 – 14 years) Registration