Your First
Appointment

Thank you for booking with Sports Medicine Institute

To make your first visit as seamless as possible we ask that all new patients complete our online patient information form and upload any relevant scans, x-rays or pathology results. Our system will accept PDF, PNG and JPEG copies of your results.

If you have any trouble uploading any of your paperwork, please feel free to contact our office on 9525 3444 and one of our friendly receptionists will be happy to assist you with any issues you are having.

Upload your Registration Form

Title

First Name *

Surname *

DOB *

Address *

Suburb *

Postcode *

Home Phone

Mobile Phone *

Work Phone

Email *

Medicare Number *

Medicare Individual Reference Number (IRN) *

Expiry *

Primary Medicare Account Holder if patient is under 18

DOB

Occupation

Are you of Aboriginal or Torres Strait Islander origin? *

Next of Kin Contact *

Relationship *

Phone *

Are you in a Health Fund? *

Referrer Type & name *

Your GP’s Name

GP’s Telephone

GP’s Address

Problem to be treated *

How did you hear about us?

How did you hear about us? *

As a private patient I am aware that payment is expected at time of consultation. A $50.00 account fee applies for all accounts taken. A $60.00 non-attendance fee applies if less than 48 hours notice of cancellation is given. Non-attendance where less than 24 hours cancellation notice is given will incur a fee equivalent to the full cost of the consultation booked. As a WorkCover/third party patient, I am aware that I am liable for all expenses should the Insurance Company fail to approve payment for consultations. I undertake to pay any additional expenses incurred in recovering overdue and non-attendance fees (including cancellation at short notice) I am aware that this practice does not bulk bill. The above information is correct to the best of my knowledge. This information may vary without any further notice.

. By clicking submit you have agreed to the above conditions.

I have read the privacy information provided and understand that my information will be held by my doctor *

I agree for reports on my condition to be sent to my referring doctor *

I agree for copies to be sent to health professionals involved in my care *

I understand that any quote provided is an estimate only. The practitioner reserves the right to adjust pricing where necessary *

For WorkCover and Third Party Injuries

Injured Area/ Description

Date of Injury

Employer Name

Employer Phone

Employer Fax

Insurance Company

Claim Number

Case Manager Name

Case Manager Phone

Case Manager Fax

File Upload

Click or drag a file to this area to upload.

Paragraph Text

Please see our map below for available timed parking spots that are within walking distance to our clinic. Please ensure that you allow enough time to find suitable parking to avoid being late for your appointment.

Your First Appointment

Thank you for booking with Sports Medicine Institute

Upload your Registration Form

For WorkCover and Third Party Injuries

Your First
Appointment