(02) 4474 2200
PLEASE PRINT OUT, COMPLETE & BRING FORM INTO THE MORUYA MEDICAL CENTRE.
In the interests of comprehensive & effective patient care it is extremely important that the information we hold in your medical record is as accurate as possible. Our practice collects this information for the primary purpose of providing quality health care.We require you to provide us with your personal details & a full medical history to allow us to properly access, diagnose, treat & advise on your health care needs.
Please be reassured that all information given on this document becomes part of your medical record & therefore is kept strictly confidential & only accessible by your doctor &/or appropriately authorised clinical staff members.
Moruya Medical Centre requires your consent to collect information about you. Please tick the applicable boxes & sign for consent at the end of this form.
Please complete the sections that you believe to be relevant to your health care. Filling out this document is purely optional & you are under no obligation to fully complete. Please hand to your doctor in your appointment.
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