New Patient Form

General Information

Medicare and Health Fund Info

Emergency Contact Information

Work Information

Please list your regular GP name and Practice

Health History

The following questions are asked prior to your appointment so that your specialist can have an idea on your general health history along with your sexual function, pelvic floor, intimacy, CST History and period symptoms. Please answer as accurately as possible as these answers will help them with your initial consultation and care plan.

PLEASE ENSURE ANY RELEVANT PATHOLOGY OR RADIOLOGY HAS BEEN FORWARDED OVER FROM YOUR GP TO AVOID DELAYS ON THE DAY OF YOUR APPOINTMENT!

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Consent

The use of AI Technology

To support efficient and accurate care, some of our doctors use secure artificial intelligence (AI) tools during consultations. The AI listens in the background, capturing only relevant details for clinical documentation, which are transcribed into your electronic medical record.

Transcription is performed exclusively in Australia. Audio files are immediately destroyed after transcription, and sensitive personal information is redacted. Transcripts are encrypted, not stored in their original form, and can only be accessed by your health practitioner. These tools assist with documentation only and do not replace clinical judgment; all information is reviewed and approved by your doctor.

Your privacy is important to us, and all AI use complies with strict data protection standards. If you have any questions or concerns, please speak with our staff or your doctor before your consultation.

Important Information

It is a Medicare requirement that you have a current referral letter for your attendance.

You will be unable to make a claim to Medicare without a referral.

Please be advised that it is our policy to ask for full payment of your account on the day of your

appointment. We do not routinely bulk bill patients.

The fee for initial consultation with the Gynaecologists is is $340.00 with a rebate of $86.15 from Medicare. 

Follow up consultations with the Gynaecologists are $170.00 with a rebate of $43.35 from Medicare.

The fee for initial consultation with the Women's Health GP is is $220.00 with a rebate of $43.90 from Medicare. 

Follow up consultations with the Women's Health GP is $100.00 with a rebate of $43.90 from Medicare.

If you have any additional gynaecological procedures, these will incur further charges on the

day. You will be notified of the expenses.

● Full payment is required on the day of your appointment.

● For your convenience we accept VISA, MASTERCARD and CASH.

● We will process the Medicare rebate automatically for you at your appointment.

● If you require surgery there will be a Co-payment, which you will not be covered by

Medicare or your Health Fund.

Patient Acknowledgements and Consents (PLEASE READ CAREFULLY)

1. I confirm that I am personally responsible for payment of all medical accounts.

2. I acknowledge and consent to all personal information being used for my overall welfare and

medical care and give my permission for any of my details to be given to other health

professionals in the course of any medical treatment.

3. I consent to all patient information and clinical photographs of or relating to me to be used for

medical teaching, lectures, research, or publications. My medical information and clinical

photographs used will be de-identified.

4. I understand these acknowledgements and consents and have the authority to sign as, or

on behalf, the patient.

5. I consent to my doctor accessing My Health Record when necessary to access clinical history such as pathology, radiology and discharge summaries

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