If you do not have all the required information such as a Medicare card number, you will need to contact your practice's administration staff in-person or by calling them on 9221 2777 (Perth City) 9409 3619 (Kingsway) so they can advise you of how to proceed.

If you're unsure how to get the information you need to complete the form, you will need to contact your practice's administration staff in-person or by calling them on 9221 2777 (Perth City) or 9409 3619 (Kingsway) so they can advise you of how to proceed.

There may be outstanding required fields that you need to answer before submitting your form. You should see each field that requires an answer in a red box at the bottom of your form. Once you have answered all fields, if a signature is required, you must sign your signature electronically using your mouse or fingers in the box provided.

If you are still unable to complete the form, you can fill out the form on paper at the clinic before your appointment.

If you have already submitted this form to your practice, you do not need to complete the form again. If you're unsure whether the practice received your form submission, we suggest contacting the practice directly by calling them on 9221 2777 (Perth City) 9409 3619 (Kingsway) to ask them directly.