We require your consent to collect personal information about you. Please read this information carefully.

This practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and a full medical history so that we may properly assess, diagnose, treat and be proactive in your health care needs. To enable ongoing care, and in keeping with the Privacy Act 1988 and Australian Privacy Principles, we wish to provide you with sufficient information on how your personal information may be used or disclosed and record your consent or restrictions to this consent.

Your personal information will only be used for the purposes for which it was collected or as otherwise permitted by law. We respect your right to determine how your information is used or disclosed.

The information we collect may be collected by several different methods and examples may include; medical test results, notes from consultations, Medicare details, date collected from observations and conversations with you, and details obtained from other health care providers (e.g. specialist correspondence).

By signing below, you are consenting to the collection of your personal information and that it may be used or disclosed by the practice for the following purposes:

•  Administrative purposes in the operation of our practice.

•  Billing purposes, including compliance with Medicare requirements.

•  Follow-up reminder/recall notices, issued by SMS or email.

•  Disclosure to others involved in your health care, including treating doctors and specialists outside this practice. This may occur through referral to other doctors, or for medical tests and in the reports or results returned to us following the referrals.

•  Disclosure as required by a court of law.

•  For the purposes of research only where de-identified information is used.

•  To allow medical students and staff to participate in medical training/teaching using only de-identified information.

•  To comply with any legislative or regulatory requirements, e.g., notifiable diseases.

•  For use when seeking treatment by other doctors in this practice.

At all times we are required to ensure your details are treated with the utmost confidentiality. We will take all steps necessary to ensure your private records remain confidential.

In completing the patient registration form, you understand and agree to the following statements in relation to our use, collection, privacy and disclosure of your information.

I have read the information above and understand the reasons why my information must be collected, and the purposes for which my information may be used or disclosed. I understand that if my information is to be used for any purpose other than set out above, my further consent will be obtained.

I give permission for my personal information to be collected, used and disclosed as described above, including contact via SMS and/or my email address. I understand only my relevant personal information will be provided to allow the above actions to be undertaken and I am free to withdraw, alter or restrict my consent at anytime by notifying this practice in writing.