Update Patient Details Form

If you need to update any of your personal details, please fill in the relevant areas below.


Personal Details
Phone number with no spaces.
Phone number with no spaces.
Phone number with no spaces.
In order for us to tailor optimal and appropriate medical care
Medical Information
Next of Kin (in case of emergency)
How did you find out about us?
Appointment Reminders, Messages & Emails
You may be sent an SMS Message reminding you of your appointment time. Please advise reception staff if you do not wish to receive SMS reminders, any other messages or emails. I do consent to receive SMS reminders, messages and emails
Privacy Statement
The Midtown Medical Clinic is committed to maintaining the confidentiality of your personal health information. Your medical record is a confidential document. It is policy of this Practice to maintain security of personal health information at all times and to ensure that this information is only available to authorised members of staff. We have a more comprehensive Privacy Act Policy that you are welcome to read upon request.
Cancellation Policy
Failing to attend your appointment or multiple late cancellations may incur a cancellation fee.
Payment Policy
Full payment is required at the time of consultation. Cash, EFTPOS and credit cards are accepted. Work Cover and TAC patients are charged private fees and can claim the cost of consultations back from their Employer, Work Cover Insurer or TAC. In some situations, this may result in a gap between our fees and the amount refunded by the Employer, Work Cover Insurer and TAC. Outstanding accounts referred to our debt collecting service will incur a debt collection fee.