Use the below form to register as a patient with the Patient Portal.
Name*
Email*
Telephone
DOB
Gender —Please choose an option—FemaleMaleOther
Medicare Number
Medicare IRN
Medicare Expiry Month —Please choose an option—010203040506070809101112
Medicare Expiry Year —Please choose an option—202320242025202620272028202920302031203220332034
Address Line 1*
Address Line 2
City
State* QueenslandNew South WalesVictoriaAustralian Capital TerritoryTasmaniaSouth AustraliaWestern AustraliaNorthern Territory
Postcode*
Upload your medical documentation
Password *NOTE: Minimum of 12 characters including numbers and special characters. Strength indicator below must show 'Strong' to allow registration
Confirm Password
How did you hear about us? PatientDoctorSupplierFamily/FriendGoogleOther
Terms & Conditions
By submitting you confirm that you agree to the Privacy Policy and Terms of Sale.
Yes, I agree
Registration Type
