Fax No
Quick Enquiry
Feel free to ask us a question.
Please note we cannot give medical information or advice over email.
Forms
For your convenience please find below a list of forms for printing out and submitting either at your appointment or by faxing them in advance of your appointment to: 07 5443 9638.
If you prefer to fill them out at the practice prior to your appointment, please arrive ten minutes before your scheduled appointment time to do so.
These forms can be downloaded in Microsoft Word format or PDF format.
You will need Adobe Acrobat Reader® installed on your computer to view PDF files.
Please note- If you do not attend your appointment - a non -attendance fee will apply. This can range between $70.00-$ 250.00 depending upon the appointment.
New Patient Form - Our practice welcomes new patients. Fill one of these forms out if you wish to become one of our new patients.
Download (PDF)
Download (Word)
Transfer of Records Form- Are you a new patient of Medicine On Second and would like your medical records transferred to us from your other practice ? If so, click below . Fill out this form so reception staff can request records on your behalf.
Skin Check Form - If you are coming for your first skin check, you can save yourself some time by filling in the form to the right and presenting it when you arrive for your appointment.
Download (PDF)
Download (Word)
Patient Feedback Form - At Medicine On Second, we are always looking for ways to improve the service provided to our patients at all stages of your visit. Below you can download a patient feedback form and submit it confidentially.
Download (PDF)
Download (Word)
AS/NZS 2299 Diving Medical Examination - ( Commercial Diving Form)
Download (Word)
Medical Form for Prospective Recreational Scuba Divers - ( Recreational Divers Form)
Download (Word)
Dr Sandeep Gupta’s Initial Consultation Form
Download Part A (PDF)
Download Part B (PDF)
Please note- If you do not attend your appointment a " non attendance fee" will apply. Depending upon your appointment this will range between $ 70.00- $ 250.00
Nutritional Assesment Questionnaire
Download (PDF)
Travel assessment Questionnaire
Vasectomy Diagram
Vasectomy Information and Form
Mens Health Questionnaires for Mens Health checks with Dr David Simpson .
Please print and fill out both forms prior to your assessment .
Men's health check questionnaire
The Australian Type 2 Diabetes Risk Assessment Tool
Allergy Questionnaire for Dr Roger Morris
Allergy Questionnaire- Dr Roger Morris
Please complete form and bring with you to your consultation with Dr Roger Morris.
*** PLEASE NOTE *** ANTI-HISTAMINES ARE NOT TO BE TAKEN 72 HOURS PRIOR TO ALLERGY TESTING