Patient Registration Form

Dr Peter Stavrou - Foot & Ankle Surgeon

Completing this online registration will email your information directly to the rooms using TLS security protocols. A copy is also sent to the email address nominated in the form.

Please complete at least one contact phone number.



Workers Compensation (if applicable)


FINANCIAL INFORMATION

Medicare does not completely cover the cost of your consultation.

It is a term of the provision of these services that the patient shall be liable for all debt collection fees and charges, including but not limited to agent fees, solicitor costs and disbursements in the event that the collection is required. Other fees apply for Workcover.

In the event that a Workcover claim is rejected, it is the patients full responsibility to cover the costs of the consultations. Other fees may be incurred for fractures and their management.

It is practice policy that we do not see or treat Third Party or Public Liability cases. Should you wish to change your status from private to Third Party or Public Liability claim for this injury then you treatment will not continue. Under no circumstances will Medico-Legal reports be provided.

CONSENT

I understand that payment of the account in full is my responsibility. I consent to the release and communication of information from or to any other medical provider for the purpose of my ongoing clinical management, ongoing clinical research and audit. Privacy Act (2000) details available upon request.

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We would love to hear from you. Please call us or make an online enquiry.

Darwin Private Hospital
Ground Floor
Rocklands Drive
Tiwi NT 0810


Monday – Friday
8:30 am – 5:00 pm

If you require urgent medical attention outside of these hours call triple 0 or present to either Royal Darwin Hospital or Palmerston Regional Hospital.


Darwin Private Hospital has a dedicated carpark with 2 hours free parking using a ticket pay and display system.


A bus stop is located at the front entrance of the hospital precinct. For timetables visit Transport NT or call 08 8924 7666.


Disabled parking bays are available. The clinic is fully accessible.

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