Patient Pack

Patient Pack

Patient Registration

Welcome to our new patient registration page. You may register with us online by completing the form below, or view our print version in PDF format, print and bring along with you to your initial consultation.

Download Print Version

For more information about our practice and your initial consultation please view our Contact page.

Please phone us on 03 9890 1844 to make an appointment prior to filling in this form.

Personal details

Personal details

Person responsible for account

Person responsible for account

Medical history

Medical history

Please indicate if you have a history of the following?










Got a Question for Us?

If you have a question about any of our procedures, use the contact form below or call us for more information.

or Freecall: 1800-LASERS