In order to confirm your 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 medical chart.

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

All information provided about you 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 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.

We request YOU complete the form and that you have made the decision to have the procedure performed. Please do not get a family member or friend to complete the online patient registration form.

Adult Penile Frenulectomy Registration Form