• SAVE SIGHT INSTITUTE

    SAVE SIGHT INSTITUTE

  • SAVE SIGHT INSTITUTE CLINIC PATIENT INFORMATION FORM

  • South Block, Sydney Eye Hospital, 8 Macquarie Street, SYDNEY NSW 2000

    Tel: (02) 9382 7300

    Email: ssi.clinic@sydney.edu.au

    www.sydney.edu.au/save-sight-institute

  • PERSONAL DETAILS

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  • CONTACT PREFERENCES

  • FINANCIAL DETAILS

  • PENSION CARD / HEALTHCARE CARD

  • ARE YOU FINANCIALLY DEPENDEDNT?

  • Page 1 of 2 Your personal information will not be used for any purpose other than that for which it is collected unless it is authorised or required by law, you have given us consent to do so or its use meets one of the other exceptions under the Information Privacy Principles. To view our full privacy policy please ask reception.

  • SSI Clinic Patient Details Form

    ALTERNATIVE/EMERGENCY CONTACTS

    If the patient is under 18 years of age, please ensure to provide both parents/guardian details. All patients must have at least one person noted for emergency contact purposes.

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  • Full name and practice details required.

  • OTHER

  • Page 2 of 2 Your personal information will not be used for any purpose other than that for which it is collected unless it is authorised or required by law, you have given us consent to do so or its use meets one of the other exceptions under the Information Privacy Principles. To view our full privacy policy please ask reception.

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