Partner Registration

Partner Registration Form

Patient Registration

Registration Form Partner

  • The number you are listed as on the card
  • If applicable
  • Consents

    Toowoomba Obstetrics & Gynaecology (TOAG) at all times respect our patients' right to privacy, and informed consent for procedures within our practice, including photographic records. I understand and consent to the necessity of clinical images for medical records, preoperative and postoperative assessment, or advice on diagnosis, treatment, and management. I understand and approve the potential use of my photographs for medical research and/or patient education purposes. I understand and consent that my identity will be kept confidential; however, in some circumstances, some identifiable details may be displayed.
    Your health information is essential to ensure accurate and effective health care and service provision, this will be retained and exclusively used in the following ways. To diagnose your medical condition and provide a treatment where necessary. For administrative purposes in the operations of the practice. For communication or referral to other medical specialists, if required. For billing and collection purposes, including but not limited to compliance with Private health fund, Medicare and Health Insurance Commission requirements. De-identified information for research purposes (publication of clinical photographs or shared with your care partners). I consent to Toowoomba Obstetrics & Gynaecology, collecting my health information.
    I give TOAG and their staff permission to contact me by telephone and if necessary, leave a message. I permit Toowoomba Obstetrics & Gynaecology to provide me with documentation regarding the practice. I have read, understand, and approve all of the above information, and all my questions have been answered.
    By selecting the above box I acknowledge this replaces my signature as an e-signature
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