Patient Registration Form

Patient Registration Form

After booking your initial consultation, you may wish to complete this online Patient Registration Form prior to your appointment.

Alternatively, you may download a PDF version of this form, complete it and email to: reception@drjasonmcdarra.com.au or bring it with you on the day of your appointment.  

IMPORTANT: Only complete this form AFTER our reception staff have given you an appointment date & time to see Dr McDarra. Completing and submitting this form without speaking to our reception staff will NOT automatically result in an appointment being made.

Note: All items marked * are required.

Step 1 of 2

50%
  • Date Format: DD slash MM slash YYYY
  • Best Contact (eg: Home)
  • (Reference number is the number in front of your name on the card)
  • If Patient is a Minor (under 18)

  • Date Format: DD slash MM slash YYYY
  • (Reference number is the number in front of your name on the card)
  • Workcover or Insurance Claim

  • Date Format: DD slash MM slash YYYY

Private Health Insurance does not cover the cost of consultation in these rooms.
However, a Medicare rebate is available.

Back to top