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Patient Information

To assist us with your consultation please complete the following online form.

Alternatively you can download a PDF of the form to complete manually here. Patient Information

Check if you wish to receive SMS reminders of your appointments.

Referring Doctor

Health Insurance

Do you have Private Health Insurance

NoYes

Type of Coverage

Do you have hold a DVA Card

NoYes

Is this a WorkCover Claim (if yes please see the reception staff)

NoYes

How did you hear about us?

GPWord of mouthSocial MediaWebsiteOther

Your Privacy, Our Concern
Consent to Use Your Personal Information

Dr Ian Baxter and The Sunshine Coast Medical Weight Loss Centre complies with the Commonwealth Privacy Act and all other state and territory legislative requirements in relation to the management of personal information. We collect information that is necessary for the provision of your health care. Personal information obtained from you in your consultation may be used to provide information to various health services involved in supporting your health care management (e.g. pathology, radiology, hospitals or other specialists). I have read and understood the Privacy Policy and understand my rights and responsibilities.
I hereby consent to my personal information being released as and when required.

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