Patient Intake

Register before you meet the doctor.

Share your details once so the clinic can review and confirm your record.

Checked by clinic staff before approval
Use the main contact number for this patient.
Leave blank only if not available.
Use the same spelling you want in clinic records.
Date of Birth *
Enter the child date of birth carefully.
Gender *
Choose the gender used for clinic charting.
Leave blank if not known.
Optional, but helpful for later communication.
Submitted successfully.

Your details are now waiting in the clinic review queue. The doctor or reception team can still correct anything before the record is approved.