New Patient Registration


AgedDisabilityOther

DECLARATION

I hereby give express permission to Lake Orr Family Practice staff and Doctors to receive and supply Personal Medical Information from or to other Medical Practitioners/Specialists/Pathology/Radiology etc on my behalf.

I acknowledge that I am wholly responsible to arrange further appointments to discuss test results conducted by by Doctor at all times. I give permission to be notified by letter, phone, email or sms for all recalls and reminders. I give consent to access the Pap Smear Register (if required).

I hereby authorise Lake Orr Family Practice to process my claim through Medicare Australia.

By submitting this form you agree to these terms and conditions.*

I hereby confirm that all the above information is true and accurate.