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Form library · MED-001

GP new patient registration

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Australian GP practices registering a new patient.

Contact details, an Australian health fund, and an emergency contact. There is no government logo and no claim that the form is approved by any agency. The grey text is made up.

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Demo only, no real details

GP new patient registration

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Example only. Fictional practice: Example Medical Practice, Subiaco. Use made-up details, such as Alex Example.

DD/MM/YYYY

Privacy: Example Medical Practice collects this information to provide your care. We may share it with the people who treat you. Read our privacy policy at example.com/privacy. Example only: the practice must write its own collection notice. See GEN-002.

Fields

  • Patient details

    Name, date of birth, mobile, email and address.

  • Health fund

    The Australian fund list used on the demo.

  • Emergency contact

    Name and phone.

  • Collection notice

    A line the practice writes before anyone uses the form.

  • Signature

    Signed on the phone.

Questions

Is this a government form?

No. This form does not ask for a Medicare number. It is not a government form, and it does not use a government logo or the Commonwealth Coat of Arms.

Where does the medical history go?

It goes on the GP medical history questionnaire. This form is only for registering a new patient.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.