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PROLOGUE

PROLOGUE

FERTILITY REGISTRATION FORM
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    Welcome to Prologue!


    The whole team here at Prologue thanks you for giving us the opportunity to help you in your fertility journey. Communication is a vital part of providing excellent care and you filling in this form will allow us to communicate with you and with your permission, the rest of your team. We look forward to caring for you in every way possible. 

     

    See you soon!

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    YOUR PRIVACY


    Prologue collects information from you for the primary purpose of providing quality care. Providing us with your personal details and medical history allows us to properly assess, diagnose, treat and be proactive in your health care needs. 


    Prologue will use the information you provide in the following ways:

    • Administrative purposes in the running of our medical practice.
    • Billing purposes, including compliance with Medicare and Health Insurance Commission requirements
    • If permitted by you, update any other health professionals involved in your health care on your progress and our plan. Prologue will make sure that your personal details will remain confidential in accordance with the NSW Privacy and Personal Information Protection Act 1998. 
       

     

    By signing below, you agree that:

    • You are happy for your treating Prologue team to discuss your medical history, diagnosis, and management plan with your referring doctor and any other relevant medical specialists as required
    • You understand you are welcome to access your medical records at Prologue
    • You are responsible for and understand the fees associated with your care
    • The information you have supplied is accurate

     

    If your information is to be used for any purpose other than the above, your consent will be sought.

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Patient Registration | DR JUSTIN TUCKER
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