Please complete the relevant patient registration form for the ‘person having the consultation / procedure. All information provided is confidential and will be handled in accordance with our Privacy Policy. We appreciate your assistance by completing this as soon as possible.

Please Note

  • By completing the electronic form and signing it you are making an informed consent for the procedure to be performed on the ‘patient’. The patient may be your child or yourself.
  • For patient’s aged 15+ you must ensure you complete the registration form and that you have made an informed decision to have the procedure.
  • If you do not consent to any or all of the above or wish to discuss do not complete the form and contact our office 07 2103 2322.

1.0 Children 00 – 14 Years of Age

  • Please complete the registration consent form for children 00 to 14 years of age.
  • If one parent cannot attend the appointment please have that parent complete the non attending parental consent form.

2.0 Child Registration Form – Two parent listed on the birth certificate

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

2.1  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.

3.0 Non Attending Parental Consent

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

4.0 Other documentation we may require

  • If there are court orders in place we are required to review them and retain a copy in your child’s file.

If you have any concerns or questions please contact our office before completing any of the forms – 07 2103 2322.

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

 Child Registration Form – Parent A & Parent B
00 – 14 years

Register Here

Non Attending Parent Registration
00 – 14 years

Register Here

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

Adult Circumcision Form (15+ Years of age)

adult circumcision form
Register Here

 Vasectomy Registration Form

Register Here

Penile Frenulectomy

Register Here

Dorsal Slit Registration Form

Register Here