MACQUARIE UNIVERSITY

02 9252 9262

SYDNEY CITY

02 9252 9262

Future Appointments

Future Appointments

Future Appointments


Future Appointments
Date of Birth
Contact Information
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Patient Information
Medicare No
Min. 12mths?
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Health Questionnaire
Past use of steroids/cortisone?
Do you have a history of the following?
I give permission for clinical photographs to be taken as part of my consultation
My clinical photographs may be used for medical education purposes (doctors/nurses/medical students only)
My clinical photographs may be used for public education purposes
My consultation notes may be used in communication with other health professionals involved in my care
I would like to receive information and special offers from time to time

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