New Patient Form

New Patient Registration Form

Medical History

Emergency Contact

Important information

Melbourne Urology Centre may, on occasion, wish to communicate with you by email. All email communications are performed with particular regard to the privacy and confidentiality of your health information, however, email communication is NOT ENCRYPTED, and therefore carry a higher risk. Email does not replace other forms of communication with your practitioner, such as consultation visits. Consenting to communicate with us by email assumes the following:

You acknowledge that the privacy and confidentiality of your health information may be compromised when communicating by email without encryption.

Only non-urgent matters shall be communicated by email, as practice staff may not read all their emails on a daily basis. Urgent matters will always be communicated by telephone.

If you hare happy to receive email communications from us you will need to provide your written consent below:

Payment of Account

Privacy Legislation & Consent Form

We require your consent to collect personal information about you.

We endeavour to provide you with optimal medical care. This requires us to collect your personal and health information. At times this information may need to be shared across an extended medical team. Your information will also be used for administrative and billing purposes and may be shared with other agencies, such as Medicare and private health funds, as required. Your health information may be used for such secondary purposes as research, trials and audits. No information that personally identifies you will be disclosed for these purposes.