Patient Registration

Your privacy is important to us and the information that you provide below will be kept confidential and only used in accordance with the regulations set out in the Commonwealth Privacy Act 2010. Your contact details will only be used as required in the provision of the healthcare service that you have been referred for. Your contact details will not be used for marketing purposes and cannot be provided to any third parties without your prior consent.

Title *

First name *

Last name *

Date of Birth *

Phone *

Email Address

Street address *

Suburb *

Postcode *

State *

Do you have a Medicare?

(No)

Are you pregnant?

(No)

Is the patient a child?

(No)

Referring Doctor

Name *

Street address *

Suburb *

Postcode *

State *

Is your general practitioner different to the referring doctor?

(No)

Miscellaneous

Do you have a referral form?

(No)

One of the ways we maintain high standards is through teaching, education and research and you may have a trainee doctor, midwife or sonographer involved in your care. If you would prefer not to have a trainee involved in your care or if you have any other questions please indicate this in the comments section below.

By completing this form you give permission to Women's Imaging Group to access any records that may be relevant to the healthcare service that you have been referred for (such as prior scan reports or hospital discharge summaries). I also give consent to send relevant information to relevant medical third parties.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Download

Mon-Tues-Wed-Thur-Fri: 0800 - 1600

Saturday: Closed

Sunday: Closed

T: 02 8076 7515
F: 02 8381 0927
E: [email protected]

Level 1, 30 Blenheim Street
Randwick NSW 2031

Public parking stations are available at Royal Randwick (access from Avoca Street) and Randwick Plaza (access via Clara Street) Shopping Centres. A paid parking station is available underneath the Randwick Hospitals campus - access via Barker Street. Limited street parking is available on the surrounding streets.

Buses from the city stop on Belmore Road, while buses from Maroubra and the airport have stops on High Street.

Please note - during construction of the light rail on High street, traffic conditions and parking options may change - for the latest information - www.sydneylightrail.transport.nsw.gov.au

Request a Form

Download the practice request form to fill up.

Download

Opening Hour

Mon-Tues-Wed-Thur-Fri: 0800 - 1600

Saturday: Closed

Sunday: Closed

Our location

T: 02 8076 7515
F: 02 8381 0927
E: [email protected]

Level 1, 30 Blenheim Street
Randwick NSW 2031

Patient Registration