Client/patient registration form

We aim to protect the privacy and secure storage of your health information. You can request a copy of our privacy policy, which includes information about the collection, use and disclosure of your health information. Our Information for Clients and Rights and Responsibilities brochures are available from reception and will also provide information of how we will use your personal information.
As a patient of our service, we require you to provide us with your personal details and a full medical history, so that we may properly assess, diagnose, treat and be proactive in your health care needs. Your Client File will be accessed ONLY by other employees who may be involved in your care or providing a service, when you consent for us to provide information to a third party or when required by mandatory reporting.
I have read and understood this Patient Registration Form and agree to its intended purposes. I am aware of the responsibilities of Illawarra Women’s Health Centre and myself in relation to the service/s I shall receive and any information I share with the practice, which is stored electronically using the Medical Director/ Pracsoft system. The above information is true and correct at the time of completing this form.
DISCLAIMER: The legal age of consent to medical treatment is 14yrs of age. This is outlined in the (Property and Contracts) Act 1970 (NSW). The legal age of consent to be case managed and to make decision about your own decisions is 16yrs of age. This is outlined in the Crimes Act 1990 section 66c.