New Patient Form

Terms & Conditions

Please accept the terms:
I have read the information above and understand the reasons why my information must be collected. I am also aware that the practice has a privacy policy on handling my patient information. I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of the health care treatment given to me. I am aware of my right to access the information collected about me, except in the circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances. I agree to disclose by other doctors in other practices of my medical information to this practice. I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify this practice of. I consent to the disclosure of information pertaining to my appointments and outstanding accounts being given to the next of kin provided.

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