New Patient Registration Form



if you are a New Patient to Fairholme Surgery please bring the following to your next consultation:

1. A valid Medicare card if you have one (check expiry date).

2. If you are a Workcover patient, you will need to inform your Employer prior to the consultation and bring your employer’s contact details for verification to arrange payment through Workcover

3. If you are coming for a consultation or you are a Private patient or you intend on having a procedure eg Dressings/Suturing/Vaccinations, please bring a form of payment.

4. The practice requires payment of your account on the day of service. We accept cash, cheque and EFTPOS. If you are on a healthcare or disability card, the practice will charge a reduced fee. The practice can electronically claim your rebate on your behalf or you may wish to go to your local medicare office and personally claim your rebate. Those on an aged pension will be bulk billed.

5. Please arrive 5 minutes before your consultation to complete a New Patient Registration Form or alternatively you can complete it online below.

6. If you need to change your appointment time please inform us as soon as possible on (02) 65711077.


We look forward to seeing you.




In Case Of Emergency
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Personal History
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Thank you for completing your Online New Patient Registration Form.
This form will be automatically emailed to us ready for your next appointment.
Please call Fairholme Surgery on 02 65 711077 if you have any enquiries or wish to make / confirm an appointment.