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  • NEW PATIENT FORM

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  • EMERGENCY CONTACT

  • FINANCIAL DETAILS

  • Do you have a Medicare Card?*
  • Are you a Pensioner (Aged / Disability)?*
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  • Are you a DVA (Veteran’s Affairs) recipient?*

  • Is this a WorkCover or Worker’s Compensation visit?*
  • Do you have private health insurance for HOSPITAL?*
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  • Which doctor have you been referred to*

  • If you need surgery with Professor Singh, we strongly recommend you JOIN A PRIVATE HEALTH FUND STRAIGHT AWAY.

    If you join a health fund today, there will be a 12-month waiting period before you can use your fund.

    There is usually a wait time of up to 12 months for new appointments with Professor Singh. If you do not join a fund until your appointment with Professor Singh, you may have to wait for 2 years before your operation.

    We recommend you join one of the AHSA Health Funds Listed Here today.

  • Were you referred by your GP or another doctor?*
  • Would you like a copy of your reports to go to any other doctors?*

  • MEDICAL HISTORY **CONFIDENTIAL**

  • Do you have any other medical problems?*
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  • Have you had previous operations / surgical procedures?*

  • MEDICATIONS

  • Are you taking any blood thinning medications?*
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  • What other medications are you currently taking?*
  • Do you have any drug allergies or medications you CANNOT take*
  • Do you smoke now?*
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  • FOR ADULT FEMALE PATIENTS: Are you pregnant?
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