New Patient Information

If you are a new patient, please fill new patient registration form online or arrive 10 minutes before your appointment time to complete a new patient form or download the form below. Please bring your Medicare card and any concession or health care cards.

• POST : 12 Bulkara Street Wallsend NSW 2287
• HAND DELIVER to reception at 12 Bulkara Street Wallsend NSW 2287
• Please do not email your form. Email is not sufficiently secure to protect your privacy.
• If you unable send patient information well in advance, please arrive at least fifteen minutes early to your first appointment. This will give sufficient time to fill out forms and for reception to create your computer file.

Download & Print Form

    New Patient Information

    PATIENT DETAILS

     

    Do you Identify as:

     

     

     

    Do you participate in the National Disability Insurance Scheme?

     

     

     

    NEXT OF KIN

     

    EMERGENCY CONTACT

     

     

    BILLING CONFIRMATION

    Do you have a Medicare card?

    Do you have a DVA card?

    Do you have a concession card?

    Patients under the age of 16 are bulk billed.

     

    CLINICAL INFORMATION

     

    Would you like SMS reminders?

    I consent to receive email communications regarding my medical care  

     

    How would you like e-scripts sent to you?

    Do you require a translator?

     

    PATIENT SIGNATURE

     

    Health Information Collection and Use Consent Form

    At First GP Wallsend, we collect personal and health information about individuals for the principal purpose of helping patients manage their health and improving patient health outcomes. We require you to provide us with your personal details and a full medical history so that we can properly assess, diagnose, treat and be proactive in your healthcare needs.

    We may disclose personal and health information to other health care providers in line with our principle purpose and for research and quality assurance activities to improve individual and community health care and practice management. Some information is collected as part of the necessary process of running a business in Australia, for research and quality assurance activities to improve individual and community health care and practice management. Usually, information that does NOT identify you is used but should information that will identify you be required, you will be informed and given the opportunity to “opt out” of any involvement.

    Further, we are required to use various government identifiers. For patients, these identifiers include Individual Healthcare Identifiers (IHI), Medicare card numbers, Department of Veterans Affairs (DVA) file numbers, concession card details, and Safety Net Numbers.
    We may use your personal information and disclose about you to various government departments and other entities for billing those entities for the health services that we provide to you.

    You can obtain our privacy policy on the FirstGP website or request a copy of our privacy policy, which includes information about the collection, use and disclosure of your health information.

    We require your consent to collect personal information about you and to use the information you provide in the following ways. For reminder letters which may be sent to you regarding your health care and management.

    You can decline to have your health information used in all or some of the ways outlined above, but it may influence our ability to manage your health care to provide the best outcome for you.

    If you request in writing for information to be disclosed to third parties, we may elect to do that, and we may charge the third party for this information.

     

    • I take full responsibility to provide accurate information and update urgently if any changes to the information occur.
    • I have read the information above and understand the reasons why my information must be collected.
    • I understand that I am not obliged to provide any information requested of me, but failure to do so may compromise that quality of health care and treatment given to me.
    • I am aware of my rights to access the information collected about me, except in some circumstances where access may be legitimately withheld. I will be given an explanation in these circumstances.
    • I give consent to be part of national recall and reminder programs such as bowel screening, breast, and cervical screening, etc.
    • I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.
    • I give consent to use a third-party reminder system, “HealthEngine” to receive clinical reminders through SMS.

    I consent to the handling of my information by the practice for the purpose set out above, subject to any limitations on access or disclosure of which I notify this practice OR I am unsure and would like to discuss this further with someone from the medical practice before I sign.

     

    Billing Summary for General, Skin, and Telephone Appointments

    Bulk Billing for general GP appointments
    Children 15 years and Under
    Valid Seniors/aged Pension Concession Card
    Dept of Veterans Affairs (DVA) Gold Card. DVA white card holders will be bulk billed as per their conditions.

     

    Private General GP appointments
    Medicare card/healthcare card/disability pension card
    Regular Consultations; $80 with a Medicare Rebate of $41.20
    Long Consultations; $130 with a Medicare Rebate of $79.70

     

    Privately Billed Skin Checks
    Regular Skin Consultations; $90 with a Medicare Rebate of $41.20
    Long Skin Consultations; $140 with a Medicare Rebate of $79.70

     

    Privately Billed Telephone Consultations
    Regular Telephone Consultations; $90 with a Medicare Rebate of $41.20
    Long Telephone Consultations; $140 with a Medicare Rebate of $79.70

     

    International/Complex for General GP Consultations
    Medicare card/healthcare card/disability pension card
    Regular Consultations; $100 with a Medicare Rebate of $41.20 (if Medicare eligibility)
    Long Consultations; $160 with a Medicare Rebate of $79.70 (if Medicare eligibility)

     

    International/Complex for Telephone Consultations
    Regular Consultations; $110 with a Medicare Rebate of $41.20 (if Medicare eligibility)
    Long Consultations; $170 with a Medicare Rebate of $79.70 (if Medicare eligibility)

     

    All Patients Please Note
    Please be advised that billing for Fitness to drive will be Private billing for all patients.

     

    or

    Fill In Online form

      New Patient Information

      PATIENT DETAILS

       

      Do you Identify as:

       

       

       

      Do you participate in the National Disability Insurance Scheme?

       

       

       

      NEXT OF KIN

       

      EMERGENCY CONTACT

       

       

      BILLING CONFIRMATION

      Do you have a Medicare card?

      Do you have a DVA card?

      Do you have a concession card?

      Patients under the age of 16 are bulk billed.

       

      CLINICAL INFORMATION

       

      Would you like SMS reminders?

      I consent to receive email communications regarding my medical care  

       

      How would you like e-scripts sent to you?

      Do you require a translator?

       

      PATIENT SIGNATURE

       

      Health Information Collection and Use Consent Form

      At First GP Wallsend, we collect personal and health information about individuals for the principal purpose of helping patients manage their health and improving patient health outcomes. We require you to provide us with your personal details and a full medical history so that we can properly assess, diagnose, treat and be proactive in your healthcare needs.

      We may disclose personal and health information to other health care providers in line with our principle purpose and for research and quality assurance activities to improve individual and community health care and practice management. Some information is collected as part of the necessary process of running a business in Australia, for research and quality assurance activities to improve individual and community health care and practice management. Usually, information that does NOT identify you is used but should information that will identify you be required, you will be informed and given the opportunity to “opt out” of any involvement.

      Further, we are required to use various government identifiers. For patients, these identifiers include Individual Healthcare Identifiers (IHI), Medicare card numbers, Department of Veterans Affairs (DVA) file numbers, concession card details, and Safety Net Numbers.
      We may use your personal information and disclose about you to various government departments and other entities for billing those entities for the health services that we provide to you.

      You can obtain our privacy policy on the FirstGP website or request a copy of our privacy policy, which includes information about the collection, use and disclosure of your health information.

      We require your consent to collect personal information about you and to use the information you provide in the following ways. For reminder letters which may be sent to you regarding your health care and management.

      You can decline to have your health information used in all or some of the ways outlined above, but it may influence our ability to manage your health care to provide the best outcome for you.

      If you request in writing for information to be disclosed to third parties, we may elect to do that, and we may charge the third party for this information.

       

      • I take full responsibility to provide accurate information and update urgently if any changes to the information occur.
      • I have read the information above and understand the reasons why my information must be collected.
      • I understand that I am not obliged to provide any information requested of me, but failure to do so may compromise that quality of health care and treatment given to me.
      • I am aware of my rights to access the information collected about me, except in some circumstances where access may be legitimately withheld. I will be given an explanation in these circumstances.
      • I give consent to be part of national recall and reminder programs such as bowel screening, breast, and cervical screening, etc.
      • I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.
      • I give consent to use a third-party reminder system, “HealthEngine” to receive clinical reminders through SMS.

      I consent to the handling of my information by the practice for the purpose set out above, subject to any limitations on access or disclosure of which I notify this practice OR I am unsure and would like to discuss this further with someone from the medical practice before I sign.

       

      Billing Summary for General, Skin, and Telephone Appointments

      Bulk Billing for general GP appointments
      Children 15 years and Under
      Valid Seniors/aged Pension Concession Card
      Dept of Veterans Affairs (DVA) Gold Card. DVA white card holders will be bulk billed as per their conditions.

       

      Private General GP appointments
      Medicare card/healthcare card/disability pension card
      Regular Consultations; $80 with a Medicare Rebate of $41.20
      Long Consultations; $130 with a Medicare Rebate of $79.70

       

      Privately Billed Skin Checks
      Regular Skin Consultations; $90 with a Medicare Rebate of $41.20
      Long Skin Consultations; $140 with a Medicare Rebate of $79.70

       

      Privately Billed Telephone Consultations
      Regular Telephone Consultations; $90 with a Medicare Rebate of $41.20
      Long Telephone Consultations; $140 with a Medicare Rebate of $79.70

       

      International/Complex for General GP Consultations
      Medicare card/healthcare card/disability pension card
      Regular Consultations; $100 with a Medicare Rebate of $41.20 (if Medicare eligibility)
      Long Consultations; $160 with a Medicare Rebate of $79.70 (if Medicare eligibility)

       

      International/Complex for Telephone Consultations
      Regular Consultations; $110 with a Medicare Rebate of $41.20 (if Medicare eligibility)
      Long Consultations; $170 with a Medicare Rebate of $79.70 (if Medicare eligibility)

       

      All Patients Please Note
      Please be advised that billing for Fitness to drive will be Private billing for all patients.

       

      "This email address is not regularly monitored and is not our preferred means of communication. There is a risk that important clinical information sent to this address may be missed or not picked up, particularly time critical information. In addition, we urge all patients to carefully consider the issue of security before sending medical information via unencrypted emails. The alternative methods for communicating clinical information are below, please do not use normal post for forwarding time critical information. We encourage patients to phone the practice or make an appointment to discuss clinical issues."