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NEW PATIENT

Registration Form

A registration form must be completed for all new patients to the Lane Cove Family Medical Practice. Simply fill out the form online and submit through our SSL protected webpage or print off a copy and bring into the practice.

Click here to download 

or continue for online submission

Date Of Birth
Gender
SMS Appointments / Results / Reminders
Yes, I consent
No, I do not consent
Are you of Aboriginal or Torres Strait Islander Origin
Yes
No
Prefer Not To Say

Consent and Authorisation

Our Practice undertakes research, professional development, and quality /improvement activities to improve patient care.

All people accessing personal information for this purpose have signed a written confidentiality agreement.

I consent to my health record being reviewed as part of the quality improvement activities at this Practice.
Yes, I Consent
No, I Do not Consent

Our Practice uses a reminder system to improve the quality of your health care.  The Practice sends reminders by mail or telephone for procedures such as vaccinations, pap tests and other health reviews.

I consent to being contacted with reminders as part of the quality improvement activities at this practice.
Yes, I Consent
No, I Do Not Consent
Today's date
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