It is important that the relevant registration form is completed allowing adequate time for our doctor to review the medical history on a patient. You are required to complete each field, if there are fields you do not have information please enter n/a for not applicable in order to be able to move to the next section in the form. 

Registration & Consent Forms For Children 00 – 14 Years Of Age

Child Registration Form – Two parent listed on the birth certificate

  • For children with two parents listed on the child’s birth certificate you are not required to bring this to your appointment.


Child Registration Form – One parent only listed on the birth certificate

  • For children with one parent only listed on the child’s birth certificate you are required to upload a copy of it and bring the original with you to the appointment.
  • The doctor will verify that only one parent is listed on the birth certificate and may ask to keep a copy of the certificate which will be stored securely in your child’s patient file.
  • When completing the form please enter your details in both Parent A and Parent B sections of the form.


Non Attending Parental Consent Form

  • Any parent that cannot attend the appointment you are required to complete this form.


Court Orders

If there are court orders in place for children we are required to review them and retain a copy in your child’s file, please upload them when completing the form or bring them to your appointment. Failure to do so may result in the appointment being rescheduled or cancelled.

2 PARENT CHILD REGISTRATION

If your son has 2 parents, and both parents are listed on the birth certificate, both parents are legally required to consent to the procedure via completion of this registration form.

1 PARENT CHILD REGISTRATION

If your son has 1 parent listed on the birth certificate, you are legally required to bring the original birth certificate with you to your son’s appointment along with uploading it when completing the online registration. Failure to do so may result in your appointment being rescheduled or cancelled.

NON-ATTENDING PARENTAL CONSENT

If one parent cannot attend the appointment, that parent is required to complete this Non-Attending Parental Consent Form.

Registration & Consent Forms For Teens to Adults 15+ Years Of Age

It is important to know details about your medical history as it forms part of vital medical records. We request the form to be completed a minimum of 48 hours before your appointment as this allows adequate time for the doctor to review these records.

If you are under the care of a specialist or hospital you are required to provide a letter from the treating specialist outlining the medical history and providing approval for you to have the procedure performed medically.

You are required to complete each field, if there are fields you do not have information enter n/a for not applicable in order to be able to move to the next section in the form. 

If your are having more than one procedure on the same day you are required to complete both registration forms.

Vasectomy Registration Form

Circumcision Registration Form

Penile Frenulectomy Registration Form

Dorsal Slit Registration Form