Patient Registration / Upload Referral:
Please note that this form is for Kingswood Eye Centre patients in Glen Osmond only.
Please be aware that all accounts are to be paid in full unless prior arrangements have been made. Failure to pay accounts could result in legal action/debt collection which incurs an additional charge. If you are experiencing financial hardship please speak to the reception team prior to your consultation. Thankyou.
DISCLOSURE OF MEDICAL INFORMATION
Please list any Authorized people (Next of Kin/Partner/legal guardian etc) who you approve to make inquiries including appointment bookings, treatment plans, and medical updates on your behalf in the comment section in the above form.
IF THERE IS ANY POSSIBILITY THIS APPOINTMENT MAY BE WORKCOVER OR THIRD PARTY RELATED PLEASE NOTIFY THE RECEPTIONIST SO WE CAN ENSURE YOU ARE TREATED BY THE OPTIMAL HEALTH CARE PROVIDER FOR YOUR PRESENTING CONDITION.