Patient Registration Form

Personal Details

Looks good!
Please enter a title.
Looks good!
Please enter a first Nname.
Looks good!
Please enter a surname.
Looks good!
Please enter a date of birth.
Looks good!
Please select your gender.
Looks good!
Please enter a street address.
Looks good!
Please enter a suburb.
Looks good!
Please enter a state.
Looks good!
Please enter a postcode.
Looks good!
Please enter a valid email address.
Looks good!
Please enter a mobile phone number.

Account Details

Looks good!
Please enter the Medicare number.
Looks good!
Please enter the Medicare ref. no.
Looks good!
Please select whether you have private health insurance.

Operation Details

Looks good!
Please enter the surgeon's name.
Looks good!
Please enter the hospital.
Looks good!
Please enter the surgery date.
Looks good!
Please enter a brief description of your procedure.
You must accept the privacy policy before submitting.

About Anaesthetic Fees

The fees payable depend on many factors including the nature and complexity of your planned procedure including duration of anaesthesia. Some of these factors cannot be known in advance, therefore it is possible that the actual fee may increase from the estimate provided prior to surgery.

As Medicare and health funds do not cover the entire cost of your medical fees there will be a shortfall to pay, and this will depend on your level of cover and rebates paid by your health fund. This also applies to Workcover insurers and TAC (Transport Accident Commission).

We like to provide our patients with anaesthetic & fee information at the earliest opportunity, so we encourage you to register your details with us. To register please complete the form above and if you have any queries please contact our office.