New Patient Form

Please complete this form before booking your first appointment.

1 Service

Which service are you booking? *

2 Personal Information

Full name *

Medicare name (if different from above)

Preferred name (optional)

Preferred gender marker *

Pronouns *

Date of birth *

3 Medicare Details

Medicare Australia

Medicare number *

IRN *

Reference number

4 Contact Details

Address *

Suburb *

State *

Postcode *

Mobile number *

Email *

5 Agreements

Clinic communications *

I agree to receive appointment-related messages and clinically relevant information from TG Health Clinic by email or SMS from time to time.

Accuracy and medical updates *

I confirm that the information I provide is accurate to the best of my knowledge. I understand that safe care depends on honest and complete information. I agree to keep the clinic informed of any important changes to my medical history, medications, or health status.

No-show fees apply *

I understand that late cancellations (less than 2 clinic days' notice) or non-attendance may be charged a fee equal to the full appointment cost.

Questions? Contact us or call 0493 108 844