Two Parent Registration 0–15 Years of Age
For all enquiries relating to a Circumcision please complete all fields below.
Two Parents On Birth Certificate 00 – 14 Years of Age
For all enquiries relating to a Circumcision please complete all fields below.
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Child Circumcision Registration
- When completing the online registration will be encrypted & transmitted to our office, we add it to your son’s records. By completing & signing it you are making an informed decision and consent to the procedure being performed.
- If you do not consent to some or all of the sections in this form do not submit the form and contact our office to discuss – 07 2103 2322.
- Most fields are mandatory, if you do not have the answer please enter n/a for not applicable
- If you do not have your son on your Medicare card at the time of registration please enter a parents Medicare card number, reference and expiry date.
- All information provided by you is confidential and will be handled in accordance with our Privacy Policy.
- If there are two parents listed on your son’s birth certificate, both parents are legally required to consent to the procedure.
- If there is one parent only listed on the birth certificate you are required to upload this when completing the online form and bring the original with you to the appointment.
- If a parent cannot attend the appointment, that parent is required to complete the Non-Attending Parental Consent Form.
Please complete all fields in order to be able to submit it. If you are attending for a consultation only regarding a Circumcisionfor your son we still request this form is completed.