FOR NEW PATIENTS

Patient Registration

Complete this registration form ahead of your initial consultation. It gives our surgical team the information they need to provide safe, personalised care. All information is kept confidential.

Sections marked optional can be skipped if not relevant. If you are unsure about any medical question, leave it blank and discuss with the surgeon at consultation.

Personal details

Insurance & ACC

Do you have insurance?
Is this an ACC claim?

Emergency contact

Doctor & medical information

Medical history

If you answer Yes to any of the questions below, please describe in the box that follows.

Are you currently taking any medications?
Do you have any allergies?
Have you had any serious illness?
Have you been hospitalised in the past?

Do any of the following apply to you?

Tick all that apply.

Conditions

Lifestyle

Are you pregnant?
Do you smoke?
Do you drink alcohol?

How did you hear about us?

Referral source

By submitting, you agree to be contacted by OMS Specialists about your enquiry. We do not share your information with third parties.

Prefer to complete this form on paper or over the phone? Get in touch and the practice will work with you.

Next step

Ready to book?

NEW PATIENTS

Request an appointment

Tell us your preferred times — we will be in touch within 1 business day.

Request appointment

BEFORE YOUR VISIT

What to expect

A complete guide to your initial consultation, sedation prep, and post-operative care.

My appointment

QUESTIONS

Contact the clinic

Prefer to complete this over the phone? Our reception team can help.

Contact us