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New patient registration

If you are a new patient to our clinic, please complete the following online registration form to prepare for your appointment.  Alternatively, this can be completed on the day of your appointment, but we request that you arrive 10 minutes early to allow time to do this.  

  • Child Details

  • DD slash MM slash YYYY
  • Parent/guardian 1

  • DD slash MM slash YYYY
    (for Medicare claiming purposes)
  • Parent/guardian 2

  • Referrer Details

  • (if different to above)
  • This field is for validation purposes and should be left unchanged.

Find us

Main Clinic
17 Murray Street
Clayton VIC 3168

Directions

St John of God
75 Kangan Dr
Berwick VIC 3806

Directions

Contact us

(03) 8572 1222
9am – 5pm
Mon – Fri

Make an Enquiry