• Patient Registration Form

Patient Information for Dr Danielle Wadley – 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.



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.

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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