Registration form - Appts/ Registration form/Fees

Appts/ Registration form/Fees : Registration form

New Patient Registration Form

Patient details

First Name

Middle Name

Surname

Child is also known as (AKA)

Date of birth

/ /

Child’s Sex

Address

Suburb

State

Postcode

School / Daycare

Parents / Legal Guardians Details 1

Name

Date of birth

/ /

Occupation

Home Phone

Work Phone

Mobile Phone

Address

Same as above

Suburb

State

Postcode

This is the only parent

Parents / Legal Guardians Details 2

Name

Date of birth

/ /

Occupation

Home Phone

Work Phone

Mobile Phone

Address

Same as above

Suburb

State

Postcode

+ Add additional parent / guardian details

Siblings

I have no siblings

Name

Sex

Date Of Birth / /

Comments

+ Add a new sibling record

Parents / Legal Guardians Details {FPARENTKEY}

Name

Date of birth

/ /

Occupation

Home Phone

Work Phone

Mobile Phone

Address

Same as above

Suburb

State

Postcode

Name

Sex

Date Of Birth / /

Comments

Bookings Online by HOT DOC

Book Appointment

Bookings by HOT DOC

You can also download the APP on your phone

if you are unable to secure an appointment then it is likley they are booked out

Allergy assessment and skin prick testing available

Dr Liz works with the Allergy team at the Royal Childrens Hospital and is trained in allergy assessment and management including skin prick testing. She is pleased to be able to offer timely access to these services at Flourish Paediatrics.

Sticking out tongue

Behavioural and developmental problems

Are you worried that your child's behaviour is more challenging then expected for age or development is behind. Dr Liz is experienced in assessment and management of ADHD, autism spectrum disorder and anxiety as well as a range of mental health and developmental problems. She works closely with an excellent network to get you the help both you and your child need.

Is your child over 6 years and still wetting the bed? Continence is one of our special interests

Find out more about the services we offer including Bell and Pad alarms for bedwetting

Vist our Health Bank pages on Continence

What is the Health Bank?

The Health Bank information hub offers a wide range of information to answer all your immediate medical questions and set you mind at rest. Find out more

A-Z of Paediatric Problems

Find out more

All you need to know about hip problems in the newborn and infant and helpful tips on how to prevent plagiocephaly

Hip Dysplasia and Plagiocephaly

Find out more

Watch the safe wrapping to prevent hip dysplasia video

Techniques to prevent or improve plagiocephaly are most effective in the first 3 months. Find out more