New Patient Registration Form and Request for Patient Portal Access

If you do not have a referral, please return to complete this form once you have a referral. Forms sent without a referral will not be processed.

DO NOT COMPLETE THIS FORM IF YOU DO NOT HAVE A REFERRAL. 

Browse
Please upload your referral here
Browse
Please upload any other relevant results or documents here

Send code
Enter your mobile phone number then click 'send code'. A code will be sent via SMS to your mobile phone which you will need to type into the form.


Privacy note: Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including our privacy policy.

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