New Patient Registration

1. Contact Information
2. Medical Accounts
3. General Information

Contact Information

Emergency Contact

General Practioner Contact

*Optional

Important Information

SWSM 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 are 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:*

Medical Accounts

Workers Compensation

*If Applicable

General Information

Sports Participation

*Optional
Please confirm you agree to the below before proceeding

SWSM is a private medical practice and fees are payable at the time of consultation. The fees charged are based on those recommended by the Australian Medical Association, these will be more than the Medicare rebate.

SWSM collects information from you for the primary purpose of providing quality healthcare. Your information is collected and held in accordance with NSW privacy legislation under which you have rights of access and correction. We require you to provide us with your personal details and a full medical history so that we may properly assist, diagnose and treat your medical condition. We will also use the information you provide us with in the following ways:

  • Administrative purposes in running our medical practice
  • Billing purposes, including compliance with Medicare and Health Insurance requirements
  • Disclosure to other General Practitioners and Specialists outside of this practice involved in your health care
  • Disclosure to other doctors within this practice

I have read and understood the above information and the reasons why my information must be collected. I understand that I am not obliged to provide any information requested of me, but that my failure to do so may compromise the quality of healthcare and treatment given to me.

I am aware of my right to access the information collected about me, except in circumstances where access might be legitimately withheld. I understand I will be given an explanation in these circumstances. For legal reasons, your request must be made in writing, and approved by your treating practitioner.