Registration Form


Other Medical Specialist involved in your care

Medical History


Financial Consent

The policy of this practice is payment on the day of consultation.  If you do not have private health insurance (hospital cover), please be aware that procedures that require a hospital admission can generate significate out of pocket costs if you chose to go ahead with the procedure.

I understand and agree to the above mentioned conditions.  I acknowlege that if I have an overdue account, that I will repay the account in a timely manner, otherwise I understand Melbourne Gut and Liver Specialists have the right to refer the account to a third party to recoup any debt accrued by myself. 

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Consent to request/release information

Occassionally, to provide a high standard of care, we may need to collect past results or investigations from other health care providers.

We may also need to disclose your information to other health care providers, or be legally bound to disclose your personal information 

 


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