• Patient Registration Form

Patient Information for Dr Andrew Morris – Orthopaedic Surgeon

You may wish to complete this online Patient Registration Form prior to your appointment. Forms are sent using normal email security protocols and a copy is sent to the email address nominated in the form.

Alternatively, you may download a PDF version of this form, complete it and bring it with you on the day of your appointment.

  Patient Registration Form PDF

Please complete at least one contact phone number.


ADF Personnel



Workers Compensation (if applicable)


FINANCIAL INFORMATION

Deviation to the above fees may occur e.g. Second opinions, medico legal and multiple injuries subject to the Doctors discretion. Other fees apply for Work Cover and Third Party. Other fees may be incurred for management, plaster casts, boots, injections, splints etc.

I agree that payment of the account in full is my responsibility. I consent to the disclosure to Medical/Specialist Practitioners, Allied Health Practitioners and institutions that may require information about my medical history, but only to the extent necessary to access/treat the particular condition that I have consulted the Specialist Practitioner about. I understand I can retract this consent at any time and to do this must do so in writing. I understand that I will be responsible for and agree to pay all Nautilus Orthopaedics accounts and will indemnify and keep indemnified Nautilus Orthopaedics from all costs, commission, fees, charges and expenses including, but not limited to solicitors costs and debt collection charges incurred by Nautilus Orthopaedics in the recovery of overdue monies. I have read and understood these terms and conditions.

DARWIN ORTHOPAEDICS

Darwin Private Hospital
Ground Floor
Rocklands Drive
Tiwi NT 0810

Ph: (08) 8920 6351
Fax: (08) 8920 6216

  Getting Here

HERVEY BAY ORTHOPAEDICS

7 Madsen Medical
Opposite Hervey Bay Hospital
Hershel Court
Urraween QLD 4655

Ph: (07) 4124 8444
Fax: (07) 4124 8411

  Getting Here

  Hervey Bay Orthopaedics Website

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