Influenza Consent Form
  • Email Correspondence Consent

    Kindly complete all information for consent to send electronic communication.
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  • Consent:

    • This is to confirm that I hereby give consent to the Family Health Clinic | Lockyer Medical Pty Ltd or Doctors & staff permission to send any electronic communication as requested via sms or email to my designated email address.
    • Kindly note that we do not correspond via email with patients for clinical conditions and so do not expect a reply for this. This requires a consultaion to be booked in.
    • All other electronic request for referral letters and scripts can be via our website and this attracts a fee.
    • This is specifically to be used for any documents which are approved by the treating Doctor only. 
    • My responses are accurate to the best of my knowledge. 
    • I have understand that any questions I may have, can be discussed with the Practice Manager.
  • Thank you for completing this online consent form online.

    Please see our Clinic privacy policy

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