Patient Registration Form

Fill all required fields (★) to submit the form.

Patient details:

Dr
Mr
Mrs
Ms
Miss
Other:

Responsible Party:

DVA (Gold/White)
Aged Pension
Workcover
TAC
N/A

Next of Kin:


Insurance Information:


Referrals:

RSDC doctors would like all the referrals to be sent no later than one day prior to the scheduled appointment. Specialist referrals are valid for 3 months and GP to specialist referrals are valid for 12 months. We recommend obtaining a a referral from your GP that will last for one year.

Information about Fees:

RSDC doctors do not bulk bill in their private rooms, however they do attend public clinics which will require a valid referral.

Payment in full is required on the day of the consultation.
For the details of RSDC fees please call our staff 1300773210.
There is an out-of-pocket cost for the Cardio Pulmonary Exercise Test and Home-Based Sleep Study for all patients.

Payment and Cancellation Policy:

In the event an appointment is cancelled with less than one business day notice, full consultation fee will be charged.


I was informed and agreed to pay the costs associated with the treatment.
I have read and accept that I am responsible for having a valid referral and for any consultation fees.

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