Greytown Medical Centre Patient Enrolment Form

We currently have a waiting list for enrolments – you will be advised as soon as we are able to enrol you . Please call us if you have any questions regarding this.

    Patient Survey

    From time to time we may contact you and ask for your feedback on your experience of care. This provides important information witch we use to improve health services. Participation is voluntary and anonymous.

    Enrolment Eligibility

    • I have read and I agree with the use of Health information statement. The information I have provided on the enrolment form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other government agencies but only when permitted under the Privacy Act
    • I confirm that if requested I can provide proof of my eligibility.
    • I agree to inform the practice of any changes in my eligibility
    • I understand that by enrolling with the practice, I will be enrolled with the Primary Health Organizations(PHO) this practice belongs to and my name, address and other identification details will be included on the practice and PHO enrolment register
    • I understand that if I visit another practice where I am not enrolled, I may be charged a higher fee.
    • I have been giveninformation about the benefits and implication of enrolment with PHO and their contact details.
    **Please attach a copy of your citizenship, residence or work visa for Identification purpose.**

    Please sign below in the space

      You will be redirected to second form for authorisation of Patient records transfer from your previous GP. Please fill the form to complete your enrolment form. Thank You