Please ensure the following is brought to your initial consult with Dr Yong:

  • Current Medicare, Health Fund and DVA card/information
  • Referral and medications list
  • Carparking is available along Jerningham Street and adjoining side streets



Please complete this form only if you have an appointment already scheduled.

New Patient Form

01  Patient Details
02  Medicare Card/ Health Fund/ Concession
Do you have Private Hospital Cover?*
Have you had Private Hospital Cover with the fund for 12 months?*
03  Health Practitioner Information
04  Emergency Contact
05  Allergies
06  Reminder Systems
This Medical Practive routinely sends SMS appointment reminders to patients
Would you like to be contacted via SMS for appointment reminders or messages?
07  Privacy Policy

We require your consent to collect personal information about you. Please read this information carefully and sign where indicated below. This Medical Practice collects information from you for the purpose of providing quality health care. We require you to provide us with your personal details and a full medical history so we may properly access, diagnose, treat and be pro-active in your health care needs. This means we will use the information you provide in the following ways.

Administrative purposes in running our medical practice.
Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.
Disclosure to others involved in your health care, including treating doctors and other specialists outside the practice. This may occur through referral to other doctors or for medical tests and in the reports or results returned to us following referrals.

Please let us know if you do not want your records accessed for these purposes and we will note your records accordingly.

I have read the above and understand the reasons why my details should be collected. I am also aware that this practice has a Privacy Policy on handling patient information. I understand that I am not obliged to provide any information requested of me, but failure to do so might comprise the quality of health care and treatment given to me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances. I understand I may be contacted by general mail-outs/specific recalls from the Practice with regards to my continuing health management.

08  Financial Consent

I understand and consent to be solely responsible for all medical expenses incurred/that can be incurred, because of a consultation, surgical procedure, radiology/pathology, and script/pharmacy. This includes any GAP (out of pocket) expenses. *I understand that the GAP cost that relates to my procedure/hospital stay may vary on the dependable. I understand that it is my responsibility to obtain the costs of gap payments from Dr Jonathan Yong, the hospital and anaesthetist that may be incurred.  I agree to pay my accounts in full by the due date. I take full responsibility for any claiming costs from the appropriate health funds and institutes.  

Thank you! Your submission has been received!
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