New Patient Registration

New Patient Registration

    Personal details

    Contact Details

    Please enter phone number with area code included. No spaces please. eg.0298765432

    Please enter phone number with area code included. No spaces please. eg.0298765432

    Please enter your full mobile number. No spaces please. eg. 0412345678

    Memberships

    10 digits

    1 digit next to cardholder's name

    eg. HCF,NIB,Bupa

    Emergency Contact

    Please enter phone number with area code included. No spaces please. eg.0298765432

    Please enter mobile or phone number with area code included. No spaces please. eg. 0298765432

    Medical Information

    Please enter phone number with area code included. No spaces please. eg.0298765432

    Consent to release medical information

    I give my consent to Dr Archie Lamb, or their agents and advisors, to contact medical practitioners or other bodies I have consulted to obtain health and other information that may be pertinent to my care.

    I authorise those medical practitioners or bodies to release such information, which may include sensitive health information to Dr Archie Lamb, or their agents and advisors, as may be requested. This is in line with the National Privacy Act updated 1st November 2010.

    For more information view our Patient Information Privacy Statement on this website.